HomeMy Public PortalAbout5734 SULTANA AVE_Sewer__ 5aZ-6312.54 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J.)"OX. COUNTY ENGINEER ADDRESS :NO.CASSATT'10.GRIFFIN, Sui'"r oP BUILDING. LOCALITY
FOR APPLICANT TO FILL IN NFARES7CROSS ST.
LEGAL WNER
BLOCK TRACT MAILG,. 6F P,LDGS.SIZE OF L.OT Novi OCa LOTGiTY � TEL.
— __.---USE OF -----
HU1LDiNGS DISTRICT NO. GROUP -j NEAP
CONTRACTOR BK PG
ADDREss -— CPJNNECTION DATA - —
CITY 7'EL,NO. _ STATION - DEPTH
Q STATE - MANhOL7 xEFERENC[
REGISTRATION NO. COUNTY Y_-.- —�. UPPER71
TYPE OF C:"dNECTION LENCTH FROM
No.. j DESCRIPTION OF WORK FEEY,___CURa P.L. _�. M-L TO F.L. �.
oHOUSE SEWER CONNECTING TO _.,... _
—!—PUBLIC SE LER _ $ 3.50
HOUSE SEWER CONNECTING TO —^
PR2 VATE DISPOSAL SYSTEM 1.00
CONNE-C1 ADD TiONAL BLDG. OR T_- CO. IMP, NO. —.— JOB. NO.
WORK TO HOUSE SEWER 1.00
_--, _-
ALTER OR REPAIR EXISTING
t !FR OR DISPCiSAL SYS1EM i-00-1 1 TRUNK PERMIT NO, ROAD PERMIT NO-
DISCONNECT
O DISCONf1t r AND ABANDON.SEVOER I i STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM _ 1.00 I _! PERMIT NO.
K, SEEPAGE PIT OR --
_ PITS AId_O.OR DRAINFIELD - 2.001 �— - 1NDUSTRIAL
WASTE APPROVAL
SPEC!-AL CONDITIONS ONLY 2,00 CHARGES
'-----"'�.'-- .i— CONNECTION CHARGE FEE
PERMIT OWNER'S _ � _ 1 ! 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE_
I HALL ?'HIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT HE A3OVE DESCRIBED EX;STING E-aL IPC ,
TO THE PL'Hc.tC SEWER — --`
NEW HOUSE SEWER,
SIGNET) Troy_e,--,_'..,AY OF_ - 9..
OWNER OR CONNECT ADDITIONAL
OWNERS ACN7- _ _ ,V. �._.._. _ -BUILDING OR WORK.___ _
SEPTIC TANK. SEEP, PIT(S)
_AND/OR DRAT NFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL[I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAMS REGULATING ALTER, REPAIR,SEWER OR�`
PLUMBING AND SEWERS. _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
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE AHA:NDON HOUSE SEWER_
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS CJ
SEEP.PIT(S) CESSPOOLS
SIGNATURE -
OF PERMITTEE�. - _
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
By sY ._
DEPUTY DEPUTY
EY HY a :4
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0 DEPUTY =DEPUTY