HomeMy Public PortalAbout5921 1/2-5923 SULTANA AVE_Sewer__ :Eee;r -62— - APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT DE COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F1011UtLO;NGJOHN A. LAMBIE, County Engineer WILLIAMI A, IENSEN, Sup'i of Bixilding —y
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FCR APPLICANT TO FILL INRG55T. �{ '
DE SCHIf TION LOT 140__. _- OWNER —
MAIL.
BLOCK TRACT � AODRE5S
NO O SLDGS.
51ZE: OF LOTNC'W ON
LOT- CITY TEL. NO.
USE OF
SU I LD I N GS DISTRICT NO. GROUP SK PG MAP PROCESS-0 BY
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ADv.iRE55,� �.� ,�, _��_--- ._CONNECTION DATA
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C I'TY L.LN-O. °' STATION +"�,.,�. )' -Y' DEPTH t ✓
f�,j' y �jy r STATE MANHOLE REFERENCE Y UF+PER
REGISTRATION NO.____C._ ®�.I S_, %� r'OUTIT. � �g w � k
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Td0_;i DES GRIP I'IC�N OF-YR�ORK_._._FEE____-__ ..._ TYPE OF (ON LENGTH FROM '
HOUSESEWER YCONNFC TNG TO �^ Y CURS P L. WL TO P.L.
PUBLIC SEWER mop
P CNO.
PITS AND/OR ORAiNF1ELD $?0.00 I -_ _` - - --
--I SEPTIC TANK '�EEPAG PIT--OR __-- .
CO IMF NO-
SEWER
O JOB NO -
I HOUSE 5 WER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. P4
PRtVA TE DISPOSAL SYSTEM '@ S3.00
_- 0
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1 CONNECT e D 7 Of`tAt BLDG OR - I AFFIDAV47 wA!vea I EASEM kriTT RECORD. If-dSTR NO.j DATE
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WORK TOHOUSE;EWER
ODER FLOW SEEPAGE-IT:,DRAINF(ELD
I FXTN:CESSPOOL,DPY WELL,mA NH OLE @ $ GO -
_ _ ----- HWY.OR S7 WIDE aNGf,.
t SALTER,REPA;R ORA
EWER OR C SPOS.ALBSYSTEMON HOUSE
53.00 STATE NGR
PERMIT Nn
-i WASTE APPRO .
HARGES
OWNER'S PERMIT � z' bo
_.__-_—___-----.___ _____
�• O� CONNECTION CHARGE FEE
AUTHORIZATION TOT�bL FEF: -_--_.----.__. _-__-_.,..._--____.-_____-_.--________._-__.-._
HAVE. AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE '
OR TD CO'.NECT THE ABOVE DESCRIBED LXIST'tNG DWELLING --_— ____ ___-- ____- _
TO THEPUBLIC SEWER APPROVALS r DATE INSPLCTOR S SIG.NAT'tf RE
SIGNED 7Hf. DOWNER
--
'` 3
O 'OWNERS A(_:E P!#.�� '' .y�e�, 6 HOU E SEWER
1 - -- NECT ADDITIONAL
t.! UILOINC OR WORK
ADORES _ _ _ - _ -..+ -- -
-- - - - - - - SEPTIC TANK,SEEP ,'T(S)
I HERCSYACKNOWLEDGE THAT i HAVE READ THIS APPLICATION ANO/'OR pRAINFIELD
i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU Mn .
NG AND SEW ERS. CESSPOOL DRYWELL ❑ j
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND./OR ALTER, REPAIR;SEWER OR
LICENSED A5 RF(�'+',1I-rt ED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
HALIFORN:A OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO D14 ONN LT PLUG AND� --
RESIDE IN. TFIE 4 Y'E DESt.RI"B�jR,,SIDENT+AL PROPERIJ. ABANDON{ OUSE SEW 51GNATvR M °'}.a BACKFILL SEPTIC TANKS
SEEP.pir(S) [: CESSPOOLS 1
��ALYBATION SING MEC A. woos
� SUPERVISING MECHANICAL ENGINEER
- CK. M. O. CASH
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ICA6420>66-s APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Las Angeles BUILpING
JOHN A. LEAIABIE, COUNTY ENGINEER -sDDRE55
7 CASSATT D. GRIFFIN, SUPT OF SUiLDINc LOCALITY
NE:ARES3
F
OR APPLICANT TO FILL IN CROSS ST. �<
LOT_N_0. OWNER_ /� tj /T::,
7- MAIL
TRAC7 �.- ,;
NO. OF BLDGS.
SiZE_OF LOT NOW.ON LOT - CITY TEL. N0.
USE OF -
BU.ILDIP@C_S, 1 ` �y �J - :.,,-°°' DISTRICT NO. GROUP I MAP _.
CONTRACTOR ./`....L-¢�.--' "j°' s
ADR FSS, � l�'' , ,�' - �.- O®1� �:`I'IOIJ DXfA --
bSTATION DEPTH
TES.. NO.r+ e114 c 1- , `— /"' --
_-- = '_ - ,,%-- ---- MANHOLE RErERENCE
-" 21 STATE
RVGISTRATION CIO ,d� [] COUNTY
NO I DESCRIPTION QR WORK FE[ __- --- - --.--- _--_ A_
-f. - .-- - --- '----- --- TYPE OF CC°r'CTION LENGTH FROM
HOUSE SEWER CONNECTING TO � � y 12A� u L. M.L. TO P.L.
_.�.. PUBLIC SFWER @ $3.50 ----.�_.�i --==- - -- -.
-- -.
SEPTIC TANK SEEPAGE PIT OR -- -�-_-
PITS AND OR DRAINFIELD Of $3.001 -- - -.--- _
--- -- -- -- ----- .:, P C. NO.
OVERFLOVi SEEPAGE PIT, DPAINF ELD
EXTN CESSPOOL DRY+ ELL.!1AN40tE (Ic $2.v0 CO. IMP NO. E`J JOB NO,
HOUE SEWER CONNECTING TO -----
�_PRIVATE DISPOSALS STEM $!,00 � � _ TRUNK PERMIT NO. ROAD PERMIT-N0. e 2
CONNECT ADDITIONAL BLDG.OR
SEWER
WORK CO HOUSE SEWER NATE ENCROACHMENT
$I_O0 �e PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - INDUSTRIAL
SEWER OR DISPOSAL SYSTEM _ $r.03 _-_ WASTE APPROVAL
CD NECTION CHARGE FEE -
OWNER'SPERMIT I 0o --- - ---------
---- - -- REIMBURSEMENT FEE
AUTHORIZATION _TOTAL FEE �~-�-_ _ SY t
i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMCD CON- APPR..OVALS � DA IE I N S P F CT O R'S S I GN AT U RE
- -- ------ ---- ---- --_.---- I_-
TRACTOR ------
-O ('ONN ri iN_Y ABOVE DESCRIBED EXiSTIPia� DWELLING --
T0 , E PL'zi;..I _:6t%, HELLP' HOUSE SE1h ER 1
OWNERS A.CLNI —.-_..DA. f�3..,�- CONNECT ADDITIONAL
SIGNED THIS——..--.—DAY
OWNER OR ��++. - '� t�. n BUILDING OR 'h0 Y .
aG4. -� " ..'t"34. EPTIC TANK,SFF'R PIT(S)
ANDIOR DRAINFIGLD
HEPEBY A K,''OWLED-E THAT HAVE' READ THIS APPLICA7I0?4
,.RID STATE Tit CE'SSPOOLD DRYWELL0
�!{E ABOVE IS C,..kf?EDI AND AC4EE TO COMPLY
WITH ALL COUNTY O1L)INANCES AND ST.AIF LASS REGUL1l ING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS EW,16F DISPOSAL SYSTEM _
IANI _ ...- -- '--- - ------' -----
HER '3Y C R !FY THAT ! PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS AN(,ELF,S COUNTY AND STATE OF ABANDON HOUSE SEWER I
CALIFORNIA OR ,HAT I AN! THE LEGAL. OWNER OF THE ABOVE
DE.SCR n.ED RESIDENTIAL PROPERLY. tCKFfLL EPT=C TANKS❑ i
SIGNATUREp ,,,,v-__ SEEP.4I T(S) (- CESSP000S
OF PERMITTEE M1
IOHN A. L.AMBIE, COUNTY ENGINEER 3y ALIDATION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR