HomeMy Public PortalAbout5724 SULTANA AVE_Sewer__ 76A942'D APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles 8UILDING
JOHNA. L.AMB1 ., COUNTY ENGIN�EIz --.aDDRFss, pg , —
CASSATT D. GRIFFIN, SU'P'T OF BUILDING LOCALITY &
NEARESr
FOR APPLICANT TO FILL IN _CROSS ST.
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DESCRIPTION LOT NO a+° /I'/.y t6' - '� OWNERMAIL
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BLOCK TRACT , ADDRESS ,F 1
i
1 f t x - --—_ _. -' LYt ¢r
i 0. OF BLDG
SIZE OF LOT i
NOW ON LOT CITY 'E' '►�+' j" F .>.4r TGE. NO. -...4..
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USE OF r
BUILDINGS , l� r p 1l ���. -- DISTRICT N0. i GROUP MAP
BK PG
CONTRACTORr`�
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"_ N CONICTION DATA — -
ADDRESS�`� / ii .. ._ 't ®3 j --- --- --- --- -
DEPTH
CITY , -�=.='- .
OrEL. Nt'� - - ------ --- ------
—_-- -''---. , I �, a �'^ s MANHOLE REFERENCE
_ STATE
REGISTRATION NO,_± 7L,-.�: 31eY"]+�' COUNTY --- ---- �-- '`-- °�-�- -
NO. DF-SUIP3'ION OF WORK FEE -- -° ------
HOUSE SEWER CONNECTING TO LENGTH FROM -
I. ,UBLIC SEWER --@ S 5_.50 :� e --- Y. —_CURB P.L. _ M L, TO P.L.
SEPTIC TANK, SEEPAGE PLT OR 1 a, _..•- i'`�' X �.✓ —_+�"` .s' w' �'4'�?'> .
_ PITS AND/OR DRAINFiEL_J C�_k $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD _ '�.+ P G. NO. �' -
I EXTN_CESSPOOL,DRYWELL.MANHOLE ^c I -4 _ 6 JOB NO.
i _ $2.00 _ _
HOUSE S—EWER CONNECTING TO I '
'
PRIVATE DISPOSAL SYSTEM (a S 1.00 I XK-j, NX P RM1 NO. R
'I CONNECT ADDITIONAL BLDG OR STATE ENCROACHM.,w -
_ WORK TO HOUSE SEINER — � $I. i _ �� _ PERMIT NO,
ALTER.REPAiR GR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 0 � INDUSTRIA_
._—._�. __.-------- "�I. WASTE APPROVAL
l I CHARGES
CONNECTION CHARGE
OVt�NER'S PERMIT _ 1� OOAUTHORIZATION TOTAL FEE - - I d< '
APPROVALS i DATE IINSPFCTOR'SSIGNATURE
-
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TC-,C OR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
0 TPUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 4"V-1 2N —19 _T -- -- J— —� — ----
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK--- - - 4
OWNERS AGE
SEPTIC TANK,SCEP,PIT(S,
ANDJOR DRAINFII:LD
ADDRESS_. I►.. — ,�_ ��__.—.—. __ _.--- _--- --I-----------+ —•_—.�____—
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWEi:L"� j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY --_--- _--. —.—..— ----;__----- ------ _-__--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING. ALTER,REPAIR,SEWER OR '.
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
I HEREBY C:ERI.F'Y THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND - —J---- - —_----------
ABANDO
ER
CALIFORNIA OR ,THAT I AM THE LEGAL OWNER OF�TTHt AB(YE --SEEP. PIN -OUSECE5`SPOOLS
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF --{I
11
DESCRIBED RESIL' TIAL PROPERTY'- L`=. BACKFILL SEPTIC TANKS ( I
SIGNATURE ----- _- --�]---
OF PERMITTE -
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IOHN A. LAMBIE,COUNTY ENGfM91ER VALIDATION ROBERT A.WOOD,CHIEF PLBG, INSPECTOR
IL 0 CASK
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