Loading...
HomeMy Public PortalAbout5826 SULTANA AVE_Sewer__ '6A 642D -CiF808 -10-71 APPLICATION FOR PER/MIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL "DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU ILOING 4psy P _ ADDRESS V & of 6 /�/ p /' , J o4 , j (; LOCALITY NEAREST FOR APPLICANT TO FILL IN CRD55 5T. ,L Y"�IV �' LEGAL �y -- - --- -- DESCRIPTION LOT NO. `03 OWNER J — MAIL BLOCK TRACT Si OS ADDRESS /336 qi i/i rte /'/.'9 L' !� NO. OF BLDGS, j Z E' SIZE OF LOT�O�`2.O NOW ON LOT / CITY (v(9V/jojCru 19 TEL. NO. �"' 5+-9 USEOF © (� BUILDINGS a/I ALJ�d jZ DIS TRICT NO. GROUP MAP pR OCESSED 8Y �'� BK PG CONTRACTOR ADDRESS +,�y j-u - ;^►y CONNECTION DATA CITY.,yL "'ry 101JV '4 TEL. NO. j -^ :j �'�� STATION r DEPTH r'r a a STATES LIC LICENSE NO. CLASS (y r MANHOLE REF E RENCEPPS < ., 'J _ / 0:-f �yFIR� NO. 1 DESCRIPTION OF WORK FEE TYPE OF CONNECTIO ' LENGTHS ROM HOUSE SEWER CONNECTING TO Y. CURB P.L.,I M.L.TO P.L. PUBLIC SEWER $7.00 { P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO. s1 y'� .108 NO. PITS AND DRAINFIELD 0 $10.00 — HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Off, PRIVATE DISPOSAL SYSTEM 0 $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIYER EASEMENT RECORD.INSTR.NO. DATE 0 WORK TO HOUSE SEWER 0 $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD w EXTN..CESSPOOL.DRYWELL. @ $5.00 0 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00 —STATE u ENCROACHMENT MANHOLE $7,00 -PERMIT NO. 0- — to --- INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ AUTHORIZATION TOTAL, FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PITS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR QRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING El AND SEWERS. CE55POOL ClDRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO SCRI 0 RI IAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE --_-��'±~ltd --. —_ OF PER MTTTEE_ x� BACKFILL SEPTIC TANKS ❑ SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION cK M.0. CASH J l,1