HomeMy Public PortalAbout5939 SULTANA AVE_Sewer__ tEA nap
'Egos-e.5a APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEINER--SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ;
- ADDRESS
JOHN A. LAMBIE, Count ' r ✓ ve;
q FSagfaees
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLI An TO FILL IN CROSS ST.
LEGAL —
DESCRIPTION Lor ND
BLOCK TRACT w MAIL
ADDRESS
NO.OF BLDG1.
SIZE OF LOT NOW ON LOT X CITY TEL.N0,
USE OF
BUILDINGS,_ DISTRICT NO. GROUP MAP PROCESSED BY
J<
BK PG
CONTRAT »
-
ADDRESS j i`Is, �° i CONNECTION DATA
CITY TEL.NO. /) j rr STATION DEPTH
E STATEUPPER
REGISTRATION NO. y COUNTY MANHOLE REFERENCE kOYVER '
NO. ! DESCRIPTION OF WORK FEE 4----
HOUSE SEWER CONNECTING'e0 -
f PUBLIC SEWER @ $9.00 _/ -:TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y, „ CURB P.L. M,L.TO P.L.
PITS AND/OR-DRAINFIELD $8,00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRI"WELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE D;SPO$AL SYSTEM @ $1.00 CO.IMP,N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0., ROAD PERMIT NO. ,
WORK TO HOUSE SEWER Q $1.00 f '
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM g $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S 1PERMIT 3 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
i^ I REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVAL. DATE I INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNET} T IHS DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE 'T'HAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRY-WELL 0 _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY' REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWN R OF TFIE ABOVE
DESCRIBED RESIDEaIA.L PROPERTY. '' 1 BACKFILL SEPTIC TANKS 0
SIGNATURE ; SEEP,PIT(S) ElCESSPOOLS
OF PERMITTE P w>
VALIDATION ROBERT A.WOOD
I `' M.Qm cAsli
SUPERVISING TNG MECHAFNICAL ENGINEER