HomeMy Public PortalAbout5935 SULTANA AVE_Sewer__ 7 T642DAPPLICATION 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
ADDRESS.
JOHN A.LAtviBIE,COUNTY ENGINEER - Y
CASSATT D. GRIFFIN, SOP•T of BUILDING LOCALITY
FOR, APPLICANT" TO FILL IN CROs sr.
LEGAL
DESCRIPTION LOT NO ,. ,y ` '""j7`✓v' "iS OWNER r"a
BLOCK TRACT �'`� j --MAIL
ES9 d+...�', F �.'- � �'- 7a,e.�.,v• � �>..'•'y�
NO. OF BLDGS..
SIZE OF LOT _ NOW ON LOT CI TEL.. ...:_ TEL. NO.,<.
USE OR
BUILDINGS _ � •.,s _ DISTRICT NO. GROUP MAA
PG
CONTRACTOR ,4 -
ONNECTION DATA
ADDRESS --I
'may —TEL NO. �✓y, ., .� ./ G STATION N- `' �"' DEPTH `„° — -
---���-- _ ��' MANHOLE REFERENCE �
4z' �r-�
z'STATE -.,—�.-- '_— 7 nl�IER
''
REGISTRATION NO, r � ['j COUNTY
NO. I DESCRIPTION OF WORK FEE --------- ------------ —
_.....f
HOU---- -- ---- - --__ ------ TYPE OF CONNECTION LENGTH FROM
SE SEWER CONNECTING TO -U, I r.
1 PUBLIC SEV ER _ 2D $3.50 Y. CURB P.L. M.L.TO P.L.
i SEPTIC TANK,SEEPAGE PIT OR-----, -
___
PITS AND/OR DRAINFIELD _ @ $3_._0.0
OVERFLOW SEEPAGE PIT,DRAINCIELD y P C. NO.
EXTN.,CESSPOO_L,DRYWELL,MAN_H_uL_E C9 $ 2.00 C.O. IMP. N__0.� _ -JOB NO. - —
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM _ _ {«-_$_1.00 TRUNK PERMIT NO. ROAD PERMIT NO
_
1 CONNECT ADDITIONAL BLDG.OR --__--_—_-___ .=s _._..
(a
dORK TO HOUSE SEFVEA, a STATE ENCROACHMENT
d
_ --..USE SEWER ----------- _--$I. I F' PERMIT NO.
ALTER,REPAIR OR ADANDON HOUSE I-_- J INDUSTRIAL ---_- -_---_----~'-
EddER 6R DISPOSAL SYSTEM - $i_Of`. I WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT _ $ 1 00 ---— --.--- — -- -- -- ----
-- ---- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE s " [7
1 HAVE AT IIHIS DATE A CONTRACT WITH THE HEREIN NiSM£D CON- - APPROVALS ALS � DATE: (INSPECTOR SSIGXATURE
-___.. ___-- ----------1- - -- • - --__ ----.
TRACTOR TO CONNECT THF ABOVE DESCRIBED EXISTING .DWELLING [ I
TO THE PUBLIC SEW-ER. NEW HOUSE SEWER I + -
i
SIGNED THIS —_—DAY OF---- CONNECT NN ADDITIONAL
OWNER OR fie y s jd y Y' --. BUILDING OR WORK _ _.-- , -----. .-----.
Oh faERo .4AENT�� SEPTIC TANK,SEEP P1Tl ) - --- -
ADDRESS —_ P ND/OR DRAINFIELD i
_I
I i+ERERY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .❑
AND STATE THA( THE t C'vE t5 CORRECT AND AGREE TO COMPLY CESSPOOLDRYIA ELL`j
WITH ALL COUNTY ORDINANCES A14D STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SE VERS. SEWAGE DISPOSAL SYSTEM �—._--
�HEREBY CERTIFY THAT 1 AM PROPERLY^REGISTERED AND/OR ABANDON
DISCONNECT
£NOUS£SEWER CdLiFORNI„ ('2 THAT` A� T'HE LEGAL OWNERYOFNTHEAABOVF. $BEP.?[T S) I CESSPOOLS'LL' ---'---- -------
DESCRIBED RES�DENTIA RJ ARTY, BACKFILL SEPTIC TANKS
LICENSED AS £L1U Til uY LOS Ah.,ELES C�U r- II
SIGNATURE ♦'4 �"Td --}` P. ( J .dOF PERMITTEE > a e 4
IOHN A. LAMBIE, C0iA4 ENGINEERVALIUATIO.�i ROBE4T A. WOOD, CHB
CHIEF PLG. INSPECTOR
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