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HomeMy Public PortalAbout5706 SULTANA AVE_Sewer__ OFO8 APPLICATION FOR PERMIT o>j >,_ss 1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF GOUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING UILD sG w _ JOHN A. LAMSIE, County Enqeer CASSATT D. GRIFFIN, Supt *I Ruildinq LOCALITY , NEAREST FOR APPLICANT TO E14 IN � CROSS ST. _ef_. :wlI LEGAL , .�- DESCRIPTION LOT N0. OWNER BLOCK TRACT �` &,.-, .� MAIL y'' N0.0ADDRESS 'F BLQGS. - - SIZE OF 4, r rNOW ON LOT CITY TEL. NO. USE OF QA's - BUILDINGS ,.9� ' DISTRICT NO. GROUP MAP PROCESSED BY ., CONTRACTOt ,,+'' n r CONNECTION DAT BK� P " -�, ��..� w 1'� ��.._: � ,.—= 1:,��� f ,;fir,� ✓ ADDRESS f yr, , � '` �" �'' CITY TEL.N0. �. STATION ' DEPTH y' B" Si`ATE MANHOLE REFERENCE REGISTRATION NO. �'- �' ❑ COUNTY NO. DESCRIPTION OF WPRK � EE• HOUSE SEWER CONNECTING TO PUBLIC SEWER $3.00 TYPE OF CONNECTION LENGTH FROM j SEPTIC TANK,SEEPAGE PIT OR Y. CURB �L. . M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C.N0, PRIVATE DISPOSAL.SYSTEM @ $1.00 CO,IMP. NO. / JOB N0. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER $1..00 TRUNK PERMIT N0. ROAD PERMIT N0. @ AI_TER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSL SYSTEM @ $1.00 PERMIT NO. fINDUSTRIAL WASTE APPROVAL CHARGES OVMR'S PERMIT $ 2 00 ;ONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE y REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ( DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. — SIGNED THIS DAY QE 19_ NEW HOUSE SEWER OWNER OR ,i CONNECT ADDITIONAL ,.•�—�- OWNERS AGENT a' bcu ''�'� _BUILDING OR WORK ADDRESS- SEPTIC TANK,SEEP. PIT($) -- - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH AL.1. COUNTY- 'ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,RREPAIR.SEWER OR SEWAGE DISPOSAL SYSTEM I HEREBY COTIFY THAT I AM PROPERLY REGI$TVkED AND/OR DISCONNECT PLUG AND LICENSED AS,+�FtEOUIRED BY LOS ANGELES COUNTY D STATE OF ABANDON HOUSE SEWER CALIFORNIA ; R IH f AM THE LEG OWNER F THE ABOVE 6ACKFILLSEPTIC TANKS El ,A SitIENTIAL PROPERTY. j � �' SEEP.PITS) ❑ CESSPOOLS SIGNATUREl «..,t_, .. 6� d' ., �sr ;.: OF PER141 V'ALIDATIONS' ROBERT A. WOOD CIL Y.C. CAsH,i SUPERMISING MECHANICAL ENGINEER /-7 24650 INSE ` 2 �° APPLICATION FOR PERMIT`- y �6A$4�askzD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOI•IN A. LAMBIE, Couray En neez ADDRESS WILLIAM A. JENSEN, Sup't of Building _LOCALITY NEAREST -� FOR APPLICANT TO (FILL IN CROSS ST. AL DESCRIPTION LOT NO. -3 OWNER BLOCK TRACT MAIL. ADDRESS NO.OF BLDGS. SIZE OF LOT '�� NOW ON LOT � CITY TEL. N0. BUIL ANG§ " ° Z y C r DISTRICT N0. GROG MBK MAP PG PROCESSED 8Y ADCREss " CONNECTION DATA CITY TEL.NO. /j STATION DEPTH STATE MANHOLE REFERENCE - UPPER REGISTRATION NO. jl COUNTY LOWER Nt1. DESCRIPTIONOFV' RK PEE • , � - - ` -'��... ' ,.7 (J � HOUSE'SEW-IR CONNECTING TO I PUBLIC SEWER @ 33.00 TYPE bF CONNECT[, LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. P1TS AND/OR DRAINFIELD @ $_3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN CESSPOOL BRYWELL @ $2.00 P.G NO, HOUSE SEWER CGNNECNNG TO F !VAT..D SPOSA SYSTEM. @ $.1.00 CO. IMP. NO. -JOB,NO. _ CONNECT, ADDITIONAL BLDG.OR WORK TO HOUSE SEWER 0) $1,00 — TRUNK PERMIT NO. ROAD PERMIT NO. ABANDON HOUSE y STATE ENCROACHMENT / ' 9: -EWER L SYSTEM_ C $1.00 PERM17 N0. �� a ; ry'" ~INDUSTRIAL. WASTE APPROVAL Pa CH RGES O�NNER'S PERMIT ?� 00 CONNECTION CHARGE FEE g AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACT'OR ON-TRACT'OR TO CONNECT THE ABOVE-'DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED TH15 O' 19— NEW HOUSE SEWER -OWNER OR OWNERSAGENCONNECT ADDITIONAL T ' I"``s(,.., BUILDING OR WORK AODR�'SS SEPTIC TANK,SEEP.PITS) ---- - AND/OR.DRAINFIELD �I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION AND STATE THAT THE ABOVE is CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑. WITH ALL COUNTY_ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SRS. 7-"` SEWAGE DISPOSAL SYSTEM I HERESY CE j rIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND L CSEO A ."EQUIRED BY LOS ANGELES COUNTY,'AND STATE OF ABANDON HOUSE SEWER CA LIFORNI P THAT I AM THE LEG OWNER-OF THE ABOVE — - BACKFILL SEPTIC TANKS ❑ SIGNATUTE - rlAL,4RJ?ERTY. ,I✓ y �R SEEP. PIT(S) El CESSPOOLS Cl. OF PE MI ;� "'� �- Al— VALIDATIO ROBERT A. WOOD CB. I o. CASH ;' SUPERVISING MECHANICAL ENGINEER r . 'E808 10-63 6A6420 APPLICAT16N��-'F' OR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING I DORES S TORN A. LAMBIE, County Engine-s AA WILLIAM A. JENSEN, Sup't of Building LOCAL. ------- N�E NEARE E ST CROSS ST FOR APPLICANT TO FILL IN ._EGA ,yol OWNER D F _34L_._:e I—ple Irl-I—, LOT NO. MAIL BLOCK TRACT -,L-- ESS ADDR NO. OF EILDGS. SIZE OF LOT NOW ON LOT CITY 'TEL, NO, USE DFDISTRICT NO. GROUP MAP _-­PR`�C�SSLD BY BUILDINGS BK PG CONTRACTOR 4- ADDRESS CONNECTION-DATA STATION DEPTH TY T.L� NO. 2. STATE UPPE REGISTRATION NO� COUNTY MANHOLE�EFERF.NrE "i NO. 'r GESCRIf'TION OF-WOPK FEE 'TYPE OF CONNECTiON LENGTH FROM __—.__T_.-_ Y. CURB M.L.TO P-L HOUSE SEWER CONNECTING TO Fusi-tc SEWER . - oi� a $-,.Do F- —--EF JOB NO. RTkCTANK,SEF PFT Co.tmp. NO. z PITS AND,.1 OF ORA!NFt=_LO @ .x!0 00 H TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 ­ CORD.INSTR NO.- ____6AT�E- CONNECT AODMONAL,SLD'.OR AFF!DAVIT ­ 1 -R EA5LMf'�T EC i WORK TO HOUSE SEWER @ $3,00 DRAIN OVERFLOW SEEPAGE PIT FIELD ,EXTN_CE,SPOOL,ORYWF�L.MANHOLE @ $5.00. -—----- HWY,OR ST.WIDENING ALTER,RE AIR ORA )-N_HOUSE SEWER,ORDiSFf@ AFENCROACH STEMENT PERMIT NO. 0, 4- INDUSTRIAL 7- WASTE A11R.1AL OWNER' CHARGES N TOTAL FEE S CONNECTION CHARGE FEE: AUTHORIZATI N TOTAL FEE REIMBURSEMENT FEE 11,HA V E: AT THIS DATE A'CONTRACT WITH THE HEREIN NAMED CON_ RAC To CONNECT HE ABOVE DESCRIBED EXISTING DWELLING' 'OR ]INSP. TOR-.SIGNATURE TO THE PUBLIC SEW APPROVALS DATE C. SIGNED THISDAY OE;--' w OWNER OR NEW HOUSE.SEWER OWNERS AG CONNECT ADDITIONAL ',v BUILDING OR WORK ADDRESS L SEPTIC TANK,SEEP.PIT(S) HFREBYiAC H, E. T T'I HAVE READ THIS APPLTIATiO.N ANO,"R GRAINFIELD AND Sj',&Tj�'THAT THE: A50V, IS CORRECT AND AGREE TO COMPLY VV'�'H �LL COZ;NTy GROIN NCF.'�, &ftn STATE LAWS REGULATING P P , STN�� F CESSPOOL. [I DRYWELL El __6M AND S EW_IRS. I HEREBY CERTIFY TNA 74 AM RROPERLY,�'RFGISTFRED AND/OR ALTER,REPA!R,SEWER OR _L ICE N�5 ASOR?%11 131 LOS EANGLES X.IJITY:�10 STATE OF SEWAGE DISPOSAL SYSTEM ED U rINER C:A L' RNIA :HAT AM THE L_ A L VIA (PD INTEND TO DISCONNECT PLUG AND R HOUSESEWE RE54DE INI, THE 7VE TISCR,SEC) iP"Ti^Z OPERTY. ABANDON R SIGNATURE BA.KF!L0L.SEPTIC TANKS E RM (S) 0 F PE,' ITT �EF.P'pil _j CESSPOOLS ROBERT A. WOOD VALIDATION CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER 2 i 24650 INSERTS CIESOPW3410 APPLICATION PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE AGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER EU(LDitiu _ BUILDING AND SAFETY DIVISION JO 1V LAMBIE, County Eng"ineeT II.LIAI+I A. IENSEN. Supt of Building LOCALITYNEARE FOR APPLICANT TO FILL IN CROSSLEGAI DESCRIPTION LOT NO. ,`..s 1, 64- ate. � OWNER BLOCK TRACT ..,"may -._ 's MAIL y 3': .c! C` ADDRESS NO.OF BS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF � " � "�.-", DISTRICT NO. GROUP - MAP PROCESSED BY BK PG .ye r CONTRACT© ;, ." - r V C sa ' ADDRESS w_ CONNECTION DATA CITY -��•: �'' TEL.NO. STATION DEPT14 N/-71 ,d ❑ STATE MA@dI{OLt RLFEFLvCE UPPER REGISTRATION NO. C [J COUNT LOWER NO. i7ESCRIPTION OF VVORK f ht7U ES WR CONNEC(1N(i TO c. PU rLiC SEWER @ $3.00 TYPE Ot CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L,TOP.L. !SITS ANL✓OR DRAINFIELD (0'7" $3.00 OVERFLOWS FPACE PI(. DRAINFIELD "N..('E SSPOOF. OPY%VEL @ $2.00 ._... H't, S WE CUN NF(T!NG TO P C.NO. ' PRIVATE DIS�-OSiAL Sr STEM �. 4I.O0 CO.1MP. RfB;--.. BOB NO. - k CGNNa CT ADDITIONAL BLDG.OR. "" TRUNK PERMIT NO. f.--`- F �• WORK TO(, USF SEWER. @ $3_00 O�&D.PERMIT N0. ALTER, REPAIR OR ABANDON HOUSE � STATE ENCROACHMENT 99 ..EWER OR.DISPOSAL SYSTEM @ $1.00 PERMIT N0, - 0 INDUSTRIAL b WASTE APPRO4,A< = _ P. a CHARGES Ol E 'S PERMIT s yy 2 OO CONNECTION CHARGE FEE AUTHO ATION TOTAL FEE � '-°` REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH e14E HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOV�D' RIBED E'X. T1NG. DWELLING API�ROVA.LS� DATE INSPECTOR°S SIGNATURE TO THE PUBLIC SEWER.SIGNED THIS .DAY O 1-9- NEW HOUSE SEWER OWNER OB OW`NERS AGENT ry CONNECT ADDITIONAL , - BUILDING OR WORK. ADDRESS. SEPTIC TANK,SEEP,PIT(S) -- .- AND/OR DRAINFIELD �I. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT :SHE ABOVE IS CORRECT AND AGREE TO COMFL.Y CESSPOOL g DRYWELL 1i Wills ALL COvTM Y ORDINANCES AND STATE LAWS REGU(,A11NG ALTER REPAIR,SEWER OR PLt1MAING ANDEWERS. SEWAGE DISPOSAL SYSTEM_ I I41;IED t QVI THAT ( S T%,EL ERLY. REGISTERED ATE OF DISCONNECT PLUG AND L}CENSED ? {lr?ED BY LOS A i:l.IS C0U '!`Y AND SCATk, 0r +;HANUON HOUSE SEWER CAL3FORH) THAT I A.M THE L 'AL W xOF THE ABOVE BACKFILLSEPTIc. TANKS {� DESti.R1r3E SigT ''(!AL PHOPEReY, Q" �°$� +.s.d f f d. .�" w SEEP.PfT(S) �i CES5P0O€,S [I I SdGNATU d ,,,$$$"` SS - -- ::Or PERMITTEE. 9FVALIDATION- ROBERT A. WOOD cll. M.0. CA511 suer VISIMG MIECHANICA.L. ENGINEER