HomeMy Public PortalAbout5705 SULTANA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER^SEWAGE DISPOSAL 1
- DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES ,
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN'% LOCALITY „��,
BUILDING NEAREST
ADDRESS �-�r�� �����_. .CROSS ST.
LOCALITY �- DISTRICT N0. - ASERIAL N0. PERMITO. c
NEAREST / J
tl
CROSS ST. Lee, ��/ BEC VEDA
� 7�Ready toy Inspection DAT SSUE
OWNER
MAILUSE ZONE OCCUPANCY M
ADDRESS � �' � �[/[2 G� /BK PG
CITY TELNO.
CONTRACTOR. CO.IMP.N0. /L Y�
ADDRESS y��� JOB.NO.
CITY Zj=mxf �, TEL.NO.. of-374 - --_
�' TRUNK PERMIT N0.
REGISTRATION NO. /�;�"�
STATE
COUNTY ROAD PERMIT N0.
DESCRIPTION LOT NO. �� �/I ,Cs! Q STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT / / INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOT o� NO.OF BLDGS. i CHARGE
NOW ON LOT
USE
BUILDINGS �-•• CONNECTION CHARGE EE
t!5•,�
�
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER IN $ 3.50 RECEIPT NO. DATE 113Y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION`RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DTE I BY
SEWER OR DISPOSAL SYSTEM 1.00
ANO%OR DISPOSAL SY TEOMN SEWER 1,00 Je
CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 . STATION i DEPTH
CESSPOOLDRYWELL
SPECIAL CONDITIONS ONLY 2.00 // p f-M L FERENCE
14,�G 1� PPER� 1 i. LTi."1SR-
TYPE OF CONNECTION _ LENGTH FROM
OWNERS .PERMIT ; � Y. �. M.L.TO P.L. /
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HERE N NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.._..___-.DAYIq_.. NEW HOUSE SEWER
OWNER OR :� CONNECT ADDITIONAL
OWNERS AGENTI..,.._.. .. BUILDING OR WORK
' SEPTIC TANK,SEEP.PIT(8)
ADDRESS------------------------- .•• AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND-SEWERS. SEWAGE DISPOSAL SYSTEM _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BAND
.Y LOS ANGELES COUNTY DISCONNECT ABANDON HOUSE PLUG PLUGSEWER
AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPT.IC.TANKS�
SIGNATURE 8EEP.PIT(S)'[] CESSPOOLS❑
OF PERMITTEE'--- �� lr�. _�_ ..............._. .
7GA642A 663 7/53 I• /�, �•�,