HomeMy Public PortalAbout5842 SULTANA AVE_Sewer__ ;E808 10-63 X91 r A
6A642 APPLICATION! FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
County EngineerIOHN A. LAMBIE, ADDREss -' .1s
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WILLIAM A. JENSEN, Supt of Building
LOCAL TY
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NEARE T ✓
FOR APPLICANT TO FILL IN RG s ST
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_-_—LEGAL
DESCRIPTION LOT NO OWN ER '' _-_ y
MAIL.
BLOCK TRACT _ ADDRESS
NO. OF LLOGS.
SIZE OF 1.0T 'i;. < NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROIiP MAP PROCESSED BY
BUILDINGS -r _
CONTRACTOR
ADDREssr, � �- �_ -- CONNECTION DATA
STATION _ DEPTH
cJT_ , x _ eL Na_ d e� — - — uwPea"—
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,� -7 MANHOLE REFERENCE: .;
REGISTRATION NO_�+ ,� GOU NT'Y
NO�I �i E.csC Rl Piz'If0N OF WORK PEE. - TYPE OF C4Nfv E,CSkON LENGTH FROM
f i HOUSE SEWER CONNECTING YO !��..i..; Y- •c-.�_,CU RB— P L. M.L Y6 P_L.. _ >_
f RU BL C SEW R 55`00 - - " P.C.NO.
�f.SEPTIC TANK,:SEEPAGE PIT OR�.. _ _ jam— LO.IMP. NO, j JOB NO. 0101
PITS AND/OR DRAT�IFIELD @ $10.Q0_�I ------ --- ---
HOUNECTi NG TO TRUNK PERMIT NO. ROAD PERMIT
I FR.VATE DISPOSAL,SYSTEM @ $3.00
CONNET AODM?IONAL BLDG-OR t� AFFIDAVIT WAiv[k EASEtA EN' I RECORD. INSTR NO. + DATE O
s:
WORK TO HOUSE SEWER @ $3.00 15
SOV ERF GW SEEPAGE PIT,DRAINFIELD Ii
I EXTN C=S P�CL,DRt WELL,MANHOLE C $5,00
.
— HWY.OR$1.WIDENING ayJ,
AL ER.REPAIR OR ABANDON HOUSE !
EN ER OR DISPOSAL SYSTEMS @ $3.00 '_i
STATE ENCROACHMENT
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PERM!! N O.
INDUSTRIAL--
_v— WASTE APPROVAL
7�
OWNEF S PERMIT ------
II QCFIARGES,��.________----.�.
AUTHORIZATION TOTAL FEE r �r CONNECTION CHARGE FEE_—__
'.1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RE.iMBU RS.E MENT FEE
TRACTOR 'TO CONNECT THE ABOVE DESCRI@EO EXISTING DWELLING -- APPROVALS
- —INSPECTOR
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TO THE PLi BLI SEWER. APPROVALS DATE INSPF:C"O R-5 51G to ATI�RE
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SIGNED THIS DAY OF � 19,x —`----� — - --- -�
OWNER OR NEW HOUSE SEWER _
OWNERS AGENTCONNECTR.DDIT CONAL --
' BUILDING OR WORKSEPTI �_
HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPL ICAT[ON ANO/ YANK,SEEP,PIT(S)
I j
AND/OR FRAINFI F,Lb �
AND STATE' THAT THE ABOVE: IS CORRECT AND AGREE .'O COMPLY' --- ----------------j---------j------- ---------"'
WITH ALL {COUNTY ORDINANi.E3 AND STATE LAWS REGULAT[NG
PLUMB ING AND SEW RS.
'CESSPOOL ❑ RYWELL C]
HEREBY CER-11Y THAT 1 AM PROPERLY REGISTERED AND;OR ALTER REPAIR,SEWER OR t
LICENSED AS REQUIRED BY LO ANGLES COUNTY AND STATE OF SEWAGE C S4 OSAL SYSTEM
CALIFORNIA OR '1-HAT I AM THE LEGAL OWNER OF, AND INTEND TO C:SCONNz:CT PLUG AND I
RsSIDE aN, THE ABOVE DFSCR19FD k'VSIDENTIA.I,. PROPER;"Y. B 1
s y, AANDON HOUSE SEWER 1
SIGNATURE ,�:_..� 3 r � �� }��` ^,� •�,� -._____ BA-KF IL SEP1'1 TANKS
OF PERMITTEE �._ ,�.b�$,�r._ _ ,:� _ - SF E.P,PIT(9• f j CESSPOOL$
VALIDATION_ ROBERT A. WOOD
SUPERVISING MECHANICAL. EN.GiNEER
CK. M.O. CASH ('{