HomeMy Public PortalAbout5710 SULTANA AVE_Sewer__ :A6420.1'
L�42D APPLICATION' FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING f -
JOHN A, LAMBIE, County Eay�neer
WILLIAM A. JENSEN, Sup"t of Buildznq LOGALtTY
NEAREST
FOR APPLICANT TO MIANCRt'r5 sT. - ti >
LEGAL
DESCRIPTION LOT N - .�t�- ,c^ .r.2 .OWNER
BLOCK TRACT T MAIL
NO.OF BLDGS.USE OF �r
SIZE OF LOT NOW ON LOT _ CITY TEL. NO.
BUILDINGS „„ + :: DISTRICT NO. GROUP MAP PROCESSES-ay
CONTRACTOR BK PG ;!l
•'� a,
ADDRESS c rj CONNECTION D�4T11
CITY `- TEL N( .L %F � A90N _j'6/ J DEPTH
r 3 '�`; ❑ STATE MANHOLE REFERENCE
REGISTRATION N0, U COUNTY
No. DESCRIPTION OF`� � FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3,00 TYPE OF CONNECTION LENGTH FR4)M
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. WL.TO P.L.
PITS AND/OR DRAIN FIELD @ 53,00
OVERFLOW SEEPAGE PIT.DRAINFIELD ✓f ,,r /•".
EXTN., CESSPOOL.DRYWELL @ $2,00 F { f •` g
HOUSE SEWER CONNECTING TOP.B o. O
PRIVATE DISPOSAL SYSTEM C� $1.00 C0.1MP, NO, :�'�- .._JOB NO.
CONNECT ADDITIONAL BLDG.OR.
'WORK TO HOUSE SEWER 51.00 TRUNK PERMIT NO. ROAD PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE
CJ'
SEWER OR DISPO5A S MEM @ $1,00 STATE ENCROACHMENT
ERMfT NO.
INDUSTRIAL
WASTE APPROVAL C=
_ CHARGES 7"
OWNER`S PERMIT $ CONNECTION CHARGE FEE
AT�VTHOMA ION T4TAI. FF.F. ;n,- ' l.'"� ' REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROXI= DATE INSPECTOR'S SIGNATURE
SIGNATURE
TO THE PUBLIC SEWER.
SIGNED "THIS -Df DP �19____� _NEW HOUSE SEWER
OWNER OR /4 _CDN ADDITIONAL
OWNERS AGENT® BUILDING OR WORK
ADDRESS SEPTIC TANS(,SEEP.PIT(S)
---- _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 ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. .,� A.LTER,REPAIR,SEWER OR
'F SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY r7.il`A 1 S PROPERLY RErISTERE AND/OR DISCONNECT PLUG AND
LICENSED AS RE4Ul[IES LOS ANGELES COUN?'Y AN PF
"STATE OP ABANDON HOUSE SEWERCAIJ !!IA OR TH•AY -AM THE LEGAL OW�'NERNE ABOVE IACKFIL:L SEPTIC TANKS 0
DESCRIBED RESIDENT J1ttROPER Y.
I �.. p FFP.P1S`(53 La CESSPOOLS
r
SIGNATURE a, 'I'L , ,. ,
OF PERMITTEES - F
VA MATIOIa, ROBERT A. WOOD
CB. lf,C t°CASZ4 i SUPERVASINIG MECHANICALINGINEER
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642 _54
SAAti42 C3 APPLICAbN FOR PERMIT
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7
IOFIN A, LAMBZE, CouatY Eng�neer
ADDRESS ' ' E .
WILLIAM A, JENSEN.Supt 0 Engineer
_ LOCALITY
,CROSS ST.
NEAREST
FOR APPLICANT TO MI. IN _
LEGAL WN p
DESCRIPTION LOT NO �. .� it.L C? ( z('_ _ O1Vt�m,R
BLOCK TRACT --�— MAIL
ADDRESS --
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT TTY TEL, NO.
USE OF
BUILDINGS V _�; &� DISTRICT NO. GROUP MAP PR4C!SSE 47 -
BIC
CONTRACTOR ^, PGy,, _4
w
ADDRESS L t a ty 7,-, �/ CONNECTION DATA
CITY TEL,NO ,F S AON ( .r DEPTH I
REGISTRATION NO. _) _ GOUNTY MANHOLE RSTATE
EFERENCE
No. I DESCRIPTION OF WORK FEE
HOUSESEWER CONNECTING TO
PUBLIC SEWER @ 18.00 " TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8.00.
OVERFLOW SEEPAGE PIT.DRAINFIELD :.
EXT'.'
CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO - `" P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, JOB N0, CJ
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER 7.00
TRUNK PERMIT N0. ROAD PERMIT N0.
$
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 _PERMIT NO LJ
W
INDUSTRIAL n,
WASTE APPROVAL V)
__CHARGES z
OWNER'S PERMIT $1 21 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE " . f'
, REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT" WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR*$SIGNATURE
TO THE PUBLIC SEWER,
SIGNED TIIiS I9P4LL 19—__ NEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT {{ �.. "% '' BUILDING OR WORK
ADORES S k SEPTIC TANK,SEEP.PIT(S)
-_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL Ll
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY-` AT I AN PROPERLY REGISTERED AND OR DISCONNECTPLUG AND
LICENSED AS RfALIMA BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA O.,R 7HA I AM THE L;OAL OW.rpIER OF THE ABOVE
DESCRIBED RES}50TIAI PROPERTY F3AGKFILL SEPTIC TANKS ❑
SIGNATiiRE '. SCEP.PITS ❑ CESSPOOLS
OF PERMI'Yf�E___._- t -- -- - - Ar3� � i f
`1'ALIDAV, ROBERT A. '1AI"OOD
C& R.O .4 ,.•-' SUPERVISING MECHANICAL,ENGINEER
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