HomeMy Public PortalAbout5937 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 y ,
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS
3 CASSATT D.GRIFFIN, SUPT OF BUILDING � •°" �-
NEAREST
FOR APPLICANT TO FILL IN CROSS ST r "4
LEGAL
DESCRIPTION LOT NO s' ) '. -� '` .OWNER d
.BLOCK TRACT MAIL
" f — ADDRESS .1
N0.OF BLDGS, [. `_-�%"° d'
SITE OF LOT NOW ON LOT ,... - CITY. „�,-� y. ... ;•, ;F._,w,.°' TEL.NO,
USE OF _ DISTRICT Nb. GROUP i- MAP
QUILDINGS �.✓; �' r G'.: I{ BK PG
CONTRACTOR l
/ CONNECTION DATA
ADDRESS -';. -jy: ¢.�, f j r M 4h.,<f 4 is ---
' ' y �-_1 j DEPTH �n _
CITY _S-A TION --
TEL NO.",4 -..� �,+ i', o' � MANHOLE
r '"-Ef'STATE �`✓�,je_ y s{.: LOWER '
REGISTRATION N0. f,,d �- ' ❑ COUNTY
NO. DESCRIPTION OF WORK FEE __�- _ - -- - ---------
HOUSE S=VER CONNECTING TO^ TYPE OF CONNECTION LENGTH FROM -
PUBLICS=WER @ $3,501 ' Y• CURB P.L. M.L.TO F.L.
- -- --- - - — 3 -�� -- ----
SEPTIC-TANK,SEEPAGE PI--T OR
AND/OR DRAINFIELD rp $3.00OTER ---------
___ --_ ELD -.,. P. C. NO.
EXTN.. ES SEEPAGE PWT,DRAIN HOLD , 7 - r -- ----_-- - -'----
EXTN .CESSPOOL,DRYWLLL,MANHOLE itt $2.00 CO, IMP N0. 0 e JOE NO. _
-I HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 � TRUNK PERMIT NO. ROAD PERMIT N0,
CONNECT ADDITIONAL BLDG.OR STATE.ENCROACHMENT
WORK TO HOUSE SEWER C' $I,00 � �- PERMIT NO.
- --1 ---- --- DO -- ---- --' -�----�---
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM fu $1,00 -
--�.- -- --- -- "--- - ----. .. ----- - -.__ 'WASTE APPROVAL
I 1 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00 — --- --- - ------ ---- ---
--- -------------- --- --- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I
HAVE A7 THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ..- ------ --._-__-APPROVALS DArF NSPECiJI S I:;. ATURE
TRAC ORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ' !
TO THE P U B LI C SEW F.R.
NEW HOUSE SEWER.
SIGNED THIS --DAY OF-. - -�D -- -- -- - - --- -- - -
.;. � CONNECT ADDIIWONAL �
OWNER OR *9 - BUILDING OR WORK
_ 1
ji�1-��-_.l. +bt' ' SEEP PIT(Sm
S - --'- ---------- -_._
OV,+.NLRB AGEtd - SEPTIC TANK, Pt + -
ADDRESS AND!OR DRAiNFI LD
L HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'CESSPO.OLE, DRYWFLLC'
AND STAY THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT l AM PROPERLY REGISTERED AND/OR —DISCONNECT PLUG AND ---I:"-_"--j-- ----__`--
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR. THAT I A'.M THE 1.5GAL,.-PINNER OF THE ABO
VE
DESCRIBED RESdDENTI.AL PROPERTY BACKFILL 5 PfIC TANKS
SIGNATURE
SEEP.PITtSr {_] CESSPOOLS
bF PERM lT7E�_. r---
---
IOHN A. LAMBIE, CoLf.y y ENGINEER VALIDATION ROBEFt!A. WOOD, CHIEF PLBG. INSPECTOR
Q. CASH