HomeMy Public PortalAbout5943 SULTANA AVE_Sewer__ DEPARTM3MT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES _
WILLIAM J. FOX, COUNTY ENGINEER ADDRE1S8 ��
FOR APPLIC. TO IN LOCALITY
BUILDING � // '� ' NEAREST s*
ADDRESS �1J a te[ CROSS ST. /7-
LOCALITY ° DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST- �/ A ,;/® t ZAe
S
CROSS ST.
RECEIVED BD Ready for Inspeet!on DATE ISSUED*
OWNER :d, -�-.� •�
ADDRESS
B
USEY�OIyEs' OCCUPANCY a PO
1 CL a
CITY TEL.NO.
CONTRACTOR CO.IMP.NO. G 3
ADDRESS JOB.NO.
C TY TEL.-NO. TRUNK PERMIT N0.
STATE
REDIST ATION_ NO. r7l?,36 ® COUNTY ROAD PERMIT N0. �
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT 6 PERMIT NO.
BLOCK TRACT Q INDUSTRIAL
v WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS.
NOW ON LOT' CHARGES
USE OF_
BUILDINGS CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE 'REIM BU RSEMENT:FEE=
HOUSE SEWERCONNECTING-TO
9 .PUBLIC SEWER 0 $ 3.60 RECEIPT NO. I DATE I BY
HOUSE SEWER'CONNECTING TO
PRIVATE DISPOSAL SYSTEM IAO
CONNECT ADDITIONAL BLDG.OR txcpklON R OROED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR RAI
2.00STATION �� DEPTH 7,,L
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �- �_MANF�"0}E�REFERENCE
TYPE 0 '•JCTIOtNHP - LENGTH FROM f'
CURB Ga°�^- M.L:.TO P.L.
OWNERS PERMIT $ I, 00
AUTHORIZATION TOTAL FEE
1.HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEC.TO.R'SSIGNATURE DATE
DWELLING TO THE P� SEWER
SIGNEDTHIS.. Y OF.--. 19-,_ NEW'HOUSE SEWER"
_ .---
OWNER OR a CONNECT ADDITIONAL
OWNERS AGENT ...... -BUILDING.OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS.--".------....._.._. -....-----------_:-.-._.............._.........._.._-._.._.... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND.STATE LAWS ALTER.REPAIR..SEWER.OR
REGULAT!NG'PL•UMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOV DESCRIBED AMSIDENTIAL PROPERTY. BACKFILL SEPTICTANK15 olry
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITT Y_:=l.s ...... _.........._......-......
TGA642D 663 1/63 / f