HomeMy Public PortalAbout5938 SULTANA AVE_Sewer__ ly
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51- APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL a
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FD
G
JOHN A. LAMBIE. County Engineer S
CASSATT D. GRIFFIN, Sup't of Building YNEARESa
FOR APPLICANT TO FILL IN CROSS ST.
- — ----- ---
LEGAL
DESCRIPTION LOT 140." OWNER -..
RLDCK-----rRACT -- --- _"� MAIL — ---- - —
5 ADDRESS
NO.OF BLDGS, ---
SIZE OF LOT - NOW 014 LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP _MAP
..CONTRACTOR.- BK _.:PG..
ADDRESS o` — CONNECTION DATA .----�—
CITY TEL.NO.. - STATION DEPTH
STATE MANHOLE REFERENCE `;UPPER
REGLSIfRATION rp COUNTY
LOWER
NO. DESCRiPr;ON OF_WO> K_
HOUSE$EW>:R CONNECTIPIG TO
I PUBLIC SEWER 3.50 I TYPE OF CONNECTION LENGTH FROM
I- SEPTIC TANK,SEEPAGE PITT OR Y. CURB P,L. AY.L.TO P,L. -
_I
PITS ANO/OR DR_AINFIELD @ $8.00
OVE`?FLOW SEEPAGE PIT DRAINFIEI_D
EXTN,.CrSSPOOI.,DRYWELL,MANHOLE Cr $2,00
HOUSE SEWER CONNECTING TOv — P.C. NO.
PRIVATE DISPOSAL-SYSTEM __ (R' $1:00 _ CO.IMP. N0, ion,
CONNECT ADDITIONAL BLDG..OR — `—
_
WORKTO HOUSE SEWER to $1_00 1 TRUNK PERMIT NO, ROAD PERMIT NO
ALTER.,REPAIR OR ABANDON HOUSE
" SEWER OR DISPOSAL SYSTEM E $I.Op STATE ENCROACHMENT
PERMfT NO,
1
IN DU STRIAi-
}--� WASTE APPROVAL
CHARGES _
3
OWNER'S PERMIT �� ;� 1OC CONNECTION CHARGE FEE
AUTHORIZATION� TOTAL FEE — -- - — —. ——EE --
_ REIMBURSEMENT FEE
3 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE 11NSPECTOR S SIGNATURE
g TO THE PUBLIC SFWER. -- - --! —I .
SIGNED THIS—_—_"-._DAY OF— 19--_ _NSW IiOus_E sswER F; _,_�
OWNC-R OR CONNECTADUI'FIONAL
OWNERS AGENT___—_.___ BUIL.DING OR WORK �L—
P,OORt 55 SEPTIC TANK,SEEP, PiT(S) ----
-- _AND/OR DRAINFIELD
9� I HERELY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ^i
AND S A"JE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL L] DRYWE_LL 0
L11'H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING —� --- — - i
"LU+�3 tiG ACIP SEWERS. ALTER REPAIR,SEINER OR — --�
ItEYEla 7" CERTIFY
THAT I AM PROPERLY REGISTERED AND/OR uEWAGF DISP05AL SYSTEM
°-N cD AS P`OUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
d CfFORNIA, OR THAT I AM THE LEGAL OWNER OF THE ABOVE _AB�IVDOPI HODS �E,WER_ _�`
DSi.RIBLD ,"E ID IITIAL PRr)PERTY. P,ACKI ILd SEPTIC TANKS
° 1:NAT U L SEEP.PIT?SI 0 CESSPOOLS 0
OF PERM TT-SE —
v.F°sza
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F VALIDATION ROBERT A. WOOD
CK, M.O. CASH SUPERVISING MECHANICAL.ENGINEER