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Home My Public Portal About5941 SULTANA AVE_Sewer__ f easaz>y APPLICATION FOR PERMIT 1 :aeasa,ae j COUNTY OF LOS ANGELES SEWER—SEWAGE ®ISPOSAL ,PEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ ,! r JOHN A. LAMBIE, County Engineer ADDRESS ? -✓ /� r �' _�- CASSATT D. GHIFF°LN,Sup"t of Building LOCALITY _ r` �L �,.� NEAREST ° FOR APPLICANT TO FILL IN CROSS ST, LEGAL DESCRIPTION LOT"%LO< , OWNER 4 �- BLOCY TRACT MAIL ADDRESS NO.OF BLDGS. r 1 SIZE OF LOT NOW ON LOT CITY: i'EL.NO. USE OF BUILDINGS °� DISTRICT NO. GROUP MAP PROCESSED BY PG BKCONTRA(C106' ' •ice :-� .-C M ��f !• W_:i: � d .�� .. �i ✓..-a. y`` _ ADDRESS +' CONNECTION DATA r C£TY'L �'—�.— _ TEL.NO.= ;>' STATION AFPTH -- j ./ STATE _ COUNTY MANHOL RE.F,ERF UPPER REGISTRATION NO.z J - _ Na. DESCRIPTION OF WORK a FEE HOUSE SEWER CONNECTING TO f' PUBLIC SEWER @ $3°00 SEPTIC SANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM r PITS AND/OR DRAINFIELD @ $3.00 Y. CURB L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE $2.00 HOUSE SEWER CONNECTING TO P. C.NO. PR.I`IATE DISPOSAL SYSTEM $1.00 CO.IMP.NO. JOB N0. GONNE,GT ADDITIONAL BLDG.OR ; WORK'r NOUS SEiNF_:R $1.QO TRUNK PERMIT NO. ROAD PERMIT NO.i ALTER, REPAIR OR ABANDON HOUSE `STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM $1.00 .---�—e PER—MIT NO. INDUSTRIAL WASTE APPROVAL CHARGE$ Ow1mrs PERMIT $ 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE s REIMBURSEMENT FEE a `_ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NLLINGOON. APPROVALSOVALR i DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIN TO THE PUBLIC SEWER. SIGNED THlS DAY ONEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP,PITS? ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL C DRYWELL 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 Aho THE LEGAL OWNER. OF..THE ABOVE DESCRIBED RESII2EGTIAL P QPERTT. 'y BACKFH L SEPTIC TANKS SEEP, PIT(S) CESSPOOLS SIGNATURE ✓� g f $r OF PER MITT 8r 'VALWATION ROBERT A.WOOD r' 9.9« CASK SUPERVISING,MZ(;HANICAL ENGINEER APPLICATION FOR PERMIT x COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIL County Engineer CASSATT D GaiFFII1,Supt of Building LOCALITY .- a t� fc'w �cT NEAREST �— FOR APPLICANT TO FILL IN CROSS ST,_._ LEGAL DESCRIPTION LOT NG +..-f s= N s OWNER ei jr CI r.--- Ya .,.-_... BLOCK TRACT MAIL ADDRESS N0.OF BLDGS. f SIZE OF LOT NOW ON LOT kr. TEL.NO. USE OF BUILDINGS DIS7t3ICT N0. GROUP g MAP PROCESSED BY CONTRA I((�Li' s r 4 T BK_ PG t t � :�1 t`� 7 ADDRESS > �z CONNECTION DATA TEL.NO, r STATION DEPTH STATE REGISTRATION N0, COUNTY MANHOLE REFERENCE UPPER IVO, DESCRIPTION OF WORK FEE ^— ~— HOUSE SEWER CONNECTING TO PUBLLC SEWER @ $3.00 -TYPE OF CONNECTION LENGTH FROM SEPTIC SEEPAGE PIT OR Pi7s AND/ORO/GR DRANFIELD @ $3.00 Xe CURB P.L. M.L,TO P.L. OVERFLOW SEEPAGE PTT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO P.C.N0. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0, ,LOB NO, CONNECT HOUSE SEWER @ $I.00 T ADDITIONAL BLDG.OR WORK. TRUNK PERMIT N0. ROAD PERMIT N0. 'r AL'iER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SE'4YER OR DISPOSAL SYSTEM a $1.00 PERMIT NO. INDUSTRIAL, n WASTE APPROVAL CHARGES OWNER'S PERT � w.`„ce CONNECTION CHARGE FEE AUTHORIZATION FTOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS DAY OI q3— NEW HORSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS. AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWE WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 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 OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, r BACKFILL SEPTIC TANKS[] cl SEEP..PITS) C7 CISSPOOLS SIGNATURE OF PERMITTE �* ':ALIDATION ROBERT A.WOOD Btc 31` K.0. emu Ii upriRvIsiNo MECt•IANICAL,ENGINEER �. #I.