HomeMy Public PortalAbout5946 SULTANA AVE_Sewer__ 7
aE-66: 11.55 APPLICATION FOR PERMIT
&E•6.63 7
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL - 1
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS � -
CASSATT D. GRIFFIN,SUP T OF'SUILDING _LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST,
LEGAL --
DESCRIPTION LOT NO ,..a-- OWNER
,,...a.�.. _L -
BLCGK TRACT ^1
MAIL
J ADDRESS
SIZE OF LOT - NOW ON LOT - CITY TEL. NO: ""
USE OF DISTRICT N'O. ! CROUP i MAP
BUILDINGS r/y PG
CONTPACTO sJ
ADDRESS _ _.` , ,, _ CONNECTION DATA
STATION ^-- -- DEPTH -- --
CIT
TEL N yg`'` (},, --- �-�- - - -
- MANHOLE REFERENCE UPPER
STATE
REGISTRATION N0. ` .�," ./ ❑ COUNTY ---�- --- ----� — -- - ...No. I DLSCRIPTION OF WORK EF - -.-- - ---- - -- .----
--fi -._ -_.-- -_-- -----' -.- ---'-- --- '� TYPE OF CONNECTION LENGTH FROM
p HOUSE SEWER CONNECTING TO � � `p k= Y. -.--- CURB P.L.-_M.L.TO P L. -
PUBLIC SEWER `@ $3;-!9, -. - -
-T-SEPTIC TANK SEEPAGE PIY'OR
_ PITS AND/OR DRAINf ILL D Ai $3.00�^ I -- - - ---�.T----_-----
OVERFLOW SEEPAGE P11, DRAINFLELD P C NO.
_] EXTN.,CESSPOOL,DRYWELL,MANHOLE t�, $2.00 i CO, IMP N0. JOB NO.
J HOUSE SEWER CONNECTING TO -- - -----�--
-��-_PRIVATE DISPOSAL SYSTEM tx'_-$1.00 1 ! TRUNK PERMIT NO. ROAD PERMIT NO. ;
CONNECT ADDITIONAL BLDG STATE ENCROACHMENT
OR ----..--- -- -
ENCRO
WORK TO HOUSE SEWER n .S I,00 i � _ PERMIT NO, -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (Yt _S 1.00_� _ WASTE APPROVAL
4 - �- -- i CHARGES
1 CONNECTION CHARGE FEE
OWNER'S PERMIT 00 —— -------------- -------- - -
_.--.. -_-_--_-_ -_..- -- RE IMBURSEMENT FEE
AUTHORIZATION TOTAL FEE � �*
1 HAVE AT "iN,S DATE A CONTRACT WITH T APPROVALS DATE INSPF.CTOR'SS;GNATURE E HEREIN NAMED COM- ..___
TRACTOR TO CONNECT" THE ABOVE DESCRIBED EXISTING. DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED TEAS .F-A—DAY OF
- CONNECT ADDITIONAL I I
OWNER OR. BUILDING OR WORK
OWNERS AGENT)-114-11 ._ �L*�,,�`_.,1',R:.«a,E -- SEPTIC TANK,SEEP PIT IS)
z
ADDRtSS -_P,P �' ._ �.,,a ,r°- � •�< - AND"OR DRAINFIFLD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION � I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR I I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT FLOG AND
CALIFORNIA OR THAT I ANI THE LEGAL OW COUNTY AND STATE OF ABANDON HOUSE SEWER
- � Y � ER OF THE ABOVE ---- --- --------- -I----.__ ..---__._-. _.------
LICENSED AS RF U1F.ED BY LCS ANGELES COU
' r
DESCRIBED P£RMITTE t BACKFILL SEPTIC TANKS LI -_
IGNAURRESIDENTIAL, I" RTS' s 1 SEEP.PIT(S) ❑ CESSPOOLS
P
SIGNATURE �. �- ;. ---- ------.-_
O€-IN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBEFRT A.WOOD, CHIEF PLBG, INSPECTOR
p w( �j �y L (� /^q
1 4 .i. 5..� JAN I mo', 1 0 Fi �.c "'t J Pte,
6AA4z0° 63 APPLICATION FOR PERMIT fF
y=a
COUNTY OF LOS ANGELES SEWER-SEWAGE DIS00 AL
DEPARTMENT OF COUNTY ENGINEER
IJUILDING AND SAFETY DIVISION FAD
11 G
JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of BuildingL TYS TS S7 F°OR APPLICANT TO FILL IN _- - � --.-- - _-- --
- - - -
4 G L
IIS•CR f +OIti LOT NO ,.,_ OWN--..R
MAIL
SL.�CK ... TRAA ADDRESS
_ `�' _.. --__
_ _ -S�dd eF
_ 0 OF SLOGS. -
SIZE OF LOT 7T X,/ J--NOW ,ON LOT CITY TEL. NO.
USE AF D TRt T NO.. rsROU" h!AP FROQzk,5Eb BY
f3U ! BK 1'G
�-r
CONTRACTOR
ADDRESS g�° _ CONNECTION DATA
NO- STATIC,N DEPTH
CITY �c TEL.
�y
n STATE MANHOLE
LOWER
P MANHCE REFERENCE
REGISTRATION NO e--_ LJ COUNTY _ --
NO. D.ESCRIPT!ON OF WORK FEE TYPE.OF CONNECTION LENGTH FROM
HOUSE SEWER CONNED-CI NG TO CURB i'.L. 'M-L:TO P.L.
PUBLIC SEWER _@ $5.00
— 154
P.C.NO, ,pv�+=
- SEPTIC TANK, SEEPAGE O
PIT R C0.(MP. Nq. JOB NO. 0
PITS ANO/OR DRAINFIELD $10.00 _____
HODS-S WER COt+Nt TING TO TRUNK.PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL. Y TEM $`1,00
—� 0.
CONNECT ADDITi O�NA AFFIDAVIT 1 WA[YER EASE MENr RECO RO. IN5TR.NO. DATE
WORK TO HOUSE SEWER $3.00 '
— _
OVERFLOW SEEPAGE Pf T.DRAitYFiELD
- EYT i.,C.E5SPOOL.JYYWEI_L,F.fANHOLE:@,15.00 D-
_,___ -. __- ___--,.______—,--____ 41WY. OR 5T.WIDENING
A LYc..Ft..R PAIR OR ABAfiP.ON Nb l„5E
i SEWER 04 DISPOSAL SYSTEM L 3.00 -"--- ---- - - - -- --__ z
__�.._._. _- STATE EN.^ROAGHMENT
PERMIT F'6___-___
--,1
INN
DL"STRIAE
WASTE APPROVAL
CHARGES
OWNER'SPER2+IIT 3 2: os ------- --- — —- ------
-_ _ _ . .-•_;- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 4
'I HAVE AT THIS DATE A CL NTRACT WITH THE.HEREIN NAMED COM. REIMBU REE
S FMNT FE
TRACTOR TO CONNECTABOVE DESCRIBED THE ABOVDESCRIBED EXISTING DWELLING - -
TO THE PLIBL C SEWER. AI'C L],OVAL T DATE INSPECTOR'S SIGNATURE
SIGNED THIS—_,.—.—_._._DAY OF—-------I9— —.—_____^_— ____�,..—._�.__— _
OWNER OR NEW HOUSE.SEWER -
OW'ERE AGE".
iT,..__—__—.—_— -___. _...—_.. _._.____._ —. CONN EG7 ADDITIONAL s.
I
BUILDING OR WORK '( _
SEPTIC,TANK.SEEP PITS)
HEREBY
ACKNO I EI�GF. THAT HAVE READ THIS .APPLICATION AND'OR DRAiNFiEt.D. I
ABOVE', IS CORRECT AND AGREE TO COMPLY
AND STATE- THAT THE
WITH AL1... C-OUNT'Y OR`DiNANCFS AND STATE LAWS. REGULAT'.ING
LU MSIPla3 AND SEWERS. CESSPOOL {� ORYW ELL
P C _
HEREBY CE:R'TIFY T:+AT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LIC FNS F.D AS REgli!RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I
I 1
. ._
GAL I4 C>RNtA OR THAT i AM THE LEGAL OWNER OF, AND INTEND TO D6sZON NECT PLUG AND
R,FSI*EE IN, 'THE" ABOVE. DESCRIBED RESIDENTIAL PROPERTY,
ABANDON HOUSE SEWER
SIGNATURE yf " . SAC K—FIL SEPTIC TANKS
QFPERMY r—
,. — -
EEP,PIT(S) r' CESSPOOLS
ALIDATIQN ROBERT A. WOOD
SUPERVISING MECHAWCAL ENGINEER
¢ CK. M.0. CASH
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