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Home My Public Portal About5716 SULTANA AVE_Sewer__ C8AB42B APPLICATION FOR PERMIT :�aoe a.5s � TEMPLE C; 1 v COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIxG d jOIltt A. LAMBIE, Countp En iuear ADDRESS d�°-, CASSATT D. GRIFFIN, Supt of Building �-:5 1'1? LOCALITY NEAREST FOR APPLICANT TO FILL IN doss ST. " 'n✓ LEGAL / p� Y DESCRIPTION LOT P10. ,� .`-�.!; ",n-_-,- ",4t-�.. e`� OWNER � ''p ,/� C,,,� �°"',�'v'i ;.,.. BLOCK TRACT MAIL s ori > �ti ADDRESS _ '- NO,'4F BLDGS. SIZE OF LOT -- NOW ON LOT gVi, IVJ2CITY 4/i C.O-10! TEL. NO_ USE OF BUILDINGS �, '.T-� DISTRICT NO. G BK MAP PG PJS -ROCESED BY CONTRACTOR t {" `71 4 �i ADDRESS CONNECTION DATA — CITY �� TEL,NO. L STATION DEPTH STATE M•A�jHOLE REFERENCE -UPPER REGISTRATION N0,t � 13 C, 3t� COUNTY - - LOWER No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENG�tt FROM SEPTIC TANK,SEEPAGE PIT OR. Y. CURB ''P,1„ M.I.'TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN_CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO '- P.C.N0. PRIVATE DISPOSAL SYSTEM @ S.1.00 CO.IMP. NO. JOB NO. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. AC .,-!?eP.A!R-vR--ABANDON HOUSE �i�. STATE ENCROACHME S,°.Vl.r?&fiDI5POSAL SYSTEM @ $i.00 PERM[T NO. J ¢ - .'• -v-;i. � WASTE APPROY4INDUSTRIAL CHARGES OWNERS Ptd MMT:'' s 2 00 CONNECTi CHARGE FEE AUTHORIZATION TOTAL FEE =-__l 1REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS L DATE INSPECTORS SIGNATURE TO THE PUBLIC SEW - SIGNED THIS 18_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGFN'i`•-•-- _ _ --- BUILDING OR WORK ADDRESS - SEPTIC TANK,SEEP.PIT($) AND/OR DRAINFIELD I HEREBY ACKNO�V LEDGE THAT I HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY . CESSPOOL ❑ DRYWEL.L ❑ WITH ALL. COUNTY' ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER.REPAIR.,SEWER OR _SEWAGE DISPOSAL SYSTEM i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I p THE ' GAL OWNER OF THE ABOVE DESCRIBED RESIDE P& P£RTY 1 - BACKFILL SEPTIC TANKS ❑ SEEP.PiT(S). ElCESSPOOLS SIGNATURE .l OF PERMITTE- ba }� VALIDATION ROBERT A. WOOD CK. M.0. CASK SUPERVISING MECHANICAL ENGINEER 24650 NSERTS Y~ 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE. DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING / BUILDING AND SAFETY DIVISION ADDREss K .�L' ]OIiN A. LA.MBIE, Countp En neer VVILLIAIyI A. JENSEN. Sup`4 of&wilding LOCALITY FOR APPLICANT TO FILLIN cRoss NEAR ST. LEGAL OWNER DESCRIPTION LOT N0. � BLOCK TRACTMAIL , ' (� r ADORES N0.OF BLDGS. SIZE OF LOT NO ON LOT [ CITY + TEL. NO. BUILDINGS y DISTRICT NO. GROUP MAP PCESSED BY BK PG CONTRACTOR /A ADDRESS -71 CONNECTION DATA CITY TEL.N } // STATION w+ DEPTH9g STATE MANHOLE REFERENCE A REGISTRATIONN NOS -• �yc.,I [1 COUNTY NO. DESCRIPTION OF WORK FEE HOUSE S--WFR-.CONNECTING TO PUBLIC SEWER @ $3.00 -" TYPE OF CTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR T. CUR '� P.L. M.L.TO F,L. PITS AND/OR DRAINFIELD @ $3.00 - - OVERFLOW SEEPAGE PIT, DRAINFIELD EXTPN,.CESSPOO1 DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO r P.C.O. PRIVATE DI-SPOSAL SYSTEM $1-00 CO.IMP. N0. ._ JOB N0. 7+ CONNECT ADDITIONAL BLDG;OR TRUNK PERMIT NO. ROAD PERMIT NO, d'- 0 WORD:TO HOUSE SEWERC@ $1.00 f + J V AI.i'ER.. RE"""OR ABANDON HOU5E STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. c_. INDUSTRIAL U WASTE APPROVAL WI CHARGES en OWN R's PERMIT S 2 00 CONNECTION CHARGE FEE 4 AUTHORIZATION TOTAL FEE �e�! 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 PUELIC SEWE SIC-NED THIS - 19- NEW HOUSE SEWER OWNER OR �.- _ .CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS. - SEPTIC TANK,SEEP.PIT(S) �._ AND/OR DRAINFIEL D I HtflZBY ACKNOWLEOGC THAT i HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVL 15 CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL E WITH ALL CO TY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR-SEWER OR PLUM BIN G TJ SEWERS. SEWAGE DISPOSAL SYSTEM I HEI;i` CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICEN,,E AS REQUIRED BY LOS ANGE ES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND CALIy'!J dA OR THAT I AM THE jti KL OWNER THE ABOVE ER DES RI ED IDENT'IAL PROPERT�'J' `BACK.FIL.L SEPTIC TAN: