HomeMy Public PortalAbout5847 SULTANA AVE_Sewer__ APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING r
JOHN A, Lr'4MBIE, COUNTY ENGINEER ADDRESS— �d �d_`4
J CASSATT t7,.GRI FF'f N, SUr'T OF BUILDINGLOCALITY -". � "" - �:,. �• '.-
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NEAREST-FOR APPLICANT TO FILL IN CROSS ST.
LEGAL -
DESCRIPTION LOT NO. � OWNER y x';v�.1v� � -_�'
BI.UCh TRACT
MA
-°� AD ORE.SS �,,y
✓NO 4F BLDGS - i , _'Molt, e .a t� 'J
SIZE OF LOT_ �!.'' � NOi4 AN LOT _
CITY TEL. NO..
USE OF DISTRICT GROUP MAPAP
PUiLDiN�s- �` ' N�_ - BK MAP
CONTRACTO
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CONNECTION DATA
ADDRESS �'=i.» i' . -_
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CITY `' a STATION DEPTH -
----
---- �T ._ L -- MANHOLE REFERENCE U°PER,
l J d' — ❑ STATE
REGISTRATION NO. `' .� ° ' '' i^], COUNTY
NO._ DESCRIPTION OF WORK�'� FEE --- -- - --- - - - ---- ----------
HOUSE CONNECTING TO - � ^., f TYPE:GF,L4SQftEGTiOR MENGTL
FROM
PUBLIC SEWER a $3 ,; s i Y. - CURB P.L. N L. TO L.
_
-.' - ...--- -' -r ---
SEPTIC TANK SEEPAGE PIT OR
--t_ PITS AND/OR DRAINFIELD �. .�3..00 .---
OVERFLOW SEEPAGE SIT..DRAINF'IELD f
AIN CESSPOOL,DRY➢4ELL.IAAN.HOLE �a _2._00OE Na+. 4_-� CO.40.. 1h1P NO T- -- -- - -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM a $1.00 I TRUNK PERMIT NG. ROAD PERMIT NO "
CONNECT ADDITIONAL.BLDG.OR -� --- �. -.--- _ r
� STATE ENCROACH MENT .'
WORK TO HOUSE $.i'Do PERMIT N0,
ALTER,,REPAIR OR AB ANCON~]OUSE -._--_ .-- --------------------_ ----
SEWER OR DISPOSAL SYSTEM t �t,Dp I � INDUSTRIAL -
-`.-- --_- _._--- --I----_--� ----- WASTE APPROVAL
f T CHARGES
i
t CONNECTION CHARGE FEE
OWNER'S PERMIT
------"'-- 0
— REIMBURSEMENT FE-EAUTHORIZATION TOTAL FEE { L :
ICONTRACT HEREIN NAMED CON- ------ --- ----..
_ - -
HAVE AT THIS DATE A APPROVALS VAT F. NNSPEC"TOP'-,SIGNATURE
R ' CONNECT THE DES
CRIsED EXiSr'a G DWELLING
7nT {r PUBLIC SEWER. NEV HOUSE
OU E SEWE_R
SIGNED THISW._ pAYOF TIG^ALCOECDDI
- - -----
OWNER GR BUILDING OR.WORK-. - I-- _- --` ---
u�
OWNERS AGENT :.' +�'.._.` - -..-- -
e - - SEPTIC TANKI SFEP,PIT($)
d,r yam' s AND/OR n4AINFIELD - 1
ADDRESS `` !r .M(+..t.-GtkY_ !� a� - ._`
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -SSPOOL,1 DRYWELLD
AND STATE THAT THE .ABOVE IS CORRECT AND AGREE TO COMPLY ____-------
WITH .ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING f
_ ALTER,REPAIR,SEWER OF,
PLUMBING
I �� DISCONNECT OSAPLUCSAYSD�tEM, I
c " Y, t c a DISCOABANDON COPSE SEWER- - '---- ---j- -- ----- - -_._._
LUM ING AND SEWER 1
3 HEREBY CERTIFY THAI [ AM PROPERLY REGISTERED ANP,GR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .
HILIFORNI' OR THAT AM THE LE+ �^"OWNER OF THE ADOVE � --- ---DESCRIBED RESIDENT! -PPOP RT � � BACKFILL SEPTIC TANK 4
.,' JEEP.TIT(SI c
1-1 CESSPOOL J
SIGNATURE
OF PERMITTEE __...---------
N- - -- ----
IOi N A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PL BG. INSPECTOR
CK. M 0 y'm5K.
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