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HomeMy Public PortalAbout5948 SULTANA AVE_Sewer__ � f � e3A6420J S3 APPLICATION FOR PERMIT COUNTY OF Los ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION SU ILD,NG JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building NEAREST FOR FOR APPLICANT TO FILL IN cRoss ST - -_ LEGAL J- ✓ -" ;+ LESCR? 'ON LDT.Np yA-'�1 .� .fa+'IQ� ��- OWN .7-" MAIL BLOCK TRACT ,G f ADDRESS NO OF BLL3G5. _ �•Z�"d'' SIZE OF LOT NOW ON LOT . EI'TY'. r '"� P ,~ TEL. N.O. USE OP_ B 1I iI..D NGS 1 DiSTRIr' t-0D. GROUP MAP PROCESSED BY gK 'G CONTRACTOR - - - CONNECTION DATA ,ADDRESS : 1 } � C �_�—__ ------ -------- -- - CITY TEL NO.../.� ..5 SjAYiON DEPIH £, ,P bTATE MANHOLE REFERENCE 4JPPEK--"_ REGISTRATIONNO �f�� - c,IIUNTY LOWER NO. GESC-R.iPTION OF WORK FEE �—_—_---.— __TYPE OF CONN;."CT ON T.-- LENGTH FROM HOUSE S WER CONNECTING TO 7`--- Y. CUXE L. P:L. M-L.TO P. . — P)S C SEWER L $5.00 1 ___ --k-. .•--•:=_.___—_____ ;; SEP C TANK SEEPAGE PIT OR PITS ANN OR DRAINFIELD@ $10.00 CO. IMF N ^_JOB NO HOU E SEWER CONNECTING TO - TRUNK PERMIT NO. ROAD PERMIT NO. ( n J ,,,j ./R + . _--___. _ —�-�— CO�•IE c.-`ADDI riON4�BLDG 6R �..—_— AFP,pAV.T, WAIVER EASEMENT RECORD. IN�iTR NO. � T ATE O WORK TO HO Sc_.SEWE.R __ __- __ ' @ $A_QO_ I,UV RFLOW ,EPAuf ,'ir.DRAINFIELD X7 .,CE S nOL,DRY YF.L L,MANHOLE $5,00 .. HWY. OR ST,WIDENING _._—_+ALTER.RE PAIr"t OR A$A NDON-4 Di;SE t✓.7- ! SEWER OR DISPOSAL SYSTEM @ $3.00 I -.___ ___.—_.— _______ _____.—_.�._____.__._—_---_.____._ - _— STATE ENCROACHMENT ACHMENT PERM T NO. INDUSTRIAL I .HASTE APPROVAL '�� OWNER'S PERMIT $' stLl ro cwARGEs------- ----- _ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE u1 sr -- ------ ------- ---------- 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CON 4ECT ?'HE ABOVE DESCRIBED EXISTING .DWELLING ----- -" ---r---- ---- -------- TO THE PU BEI- FWFR, APPROVALS DATE INSPECTOR WG-NATURE SIGNED THIS ._._ DAY OF:__,�_—�_ 19_ --- `-- ------"fi`--.__— OWNER OR NEW HOUSE SEWER OWNERS ---- ---- ---- —'----- CONNECT ADD17fONAL. I I ADDRESS � BUILDING OR WORK I SEPTIC TANK,SSFP,PIT{S.) I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD ' AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY WITH .ALL COUNTY ORDINANCES AND STATE LAWS REGULA'TING i PL'UMi3INC, AND. ':EWERS, CESSPOOL ❑ ORYWELL LI 1 HEREBY CF'.RTIFY THAT I AM PROPERLY REGiSTFRED AND/OR ALTER,REPAIR.SEWER OR ! L1:'ENSED AS REQUIRED BY 1,05 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTE.M �.AL;f"ORNIA OR THAT AY i AM THE LEGAL OWNER OF, Ah'tiD INTEND TO -"------------- "-----"--'- - DISCONNECT PL LIG AND REa1Oc. IN, THE ABOVE DESCRIBED RESIDE NTIAL PROPERTY. ABANDON HOUSE EWER, SIGN.AILIRE ,,!" --- ..: ' ' BACKFILL SFPTIC TANKS 4 Y_ ❑ --.__}_,_____—__.- OF PERMtTTEE,c-- .E�-.— ____-_._ SEEP.PIT(S) Q CESSPOOLS f Iii —VALIDATION ALIDAATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER 6:11,1*) M.O CASH z � T 4. :6A6 20 63 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TADDRESS Nt - - JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Supt off Building ✓ 7YTFOR APPLICANT TO FILL IN5T --- t_EGAL y_ OESCR PT;ON LOT NO !l.'@ u� ��'' OWNER - - � --- - , ! MAIL - -_ -- BIL OCK. TRACT W- -.� "' ADDRESS ""- O? ELCGS, gam_ - SIZE OF LOT NC,`it` UN LOT �+� GITY' '.Y >r TEL. NO. USE BU II.O OF DISTRICT D. GROUP MAP PROCESSED BY PG CONTRACTOR . ..La ADDR CONNECTION DATA ✓' �„_,.`,v -- STATION - DEPTH CITY y ' yi. TEL NO. '' .. TATE MANHO L ,I.�F:3C N(£. C —LOWER No5OUNTY _.- NO. I GESCR7PT(ON OF iNORK FEE _ TYP c..- "c . _,;rlcn! LENGTH FROM H 0 U 5 E SEWCR CON NECTI N+a'TO T-- Y. M.I-.'T0 P.L. j PLI13LIC SEWER @ SSGO SEPTIC TANK SEEPAGE PIT OR u Ta AND CR DR.A!NFIEL17 @ 510.00 CO.IMP.NO. "' JDF3 NO__�_ N 045E$EW R CON NE.T'N G-70 TRUNK PERMIT NO. ROAD PERMIT NO. f C f PRIVATE DISPOSAL SYSTEM @ S3 00 WOREhO Ao-ri SEWER __--� ---- "-"----- TWAT- ---- ---'-- -"-_-- '- WORK TOW SEEPAGE E PIT DRAINFIELD $ AFFIDAVIT V1givEQ EA�EMExr RECORD,INSTR.NO. i C)A.T€ i CON NE..T AQDI�iONAL BLDG OR I OVER _ I EXTN..CESSFOOL.DR"YWE.L'-.MANHOL E @ � .� S x.00 ,�. __- .--_-R - _. .__.__,_._ :_--_.- Htr`I 1'.OR ST'.WIDENING i AL ER,-REPAIR OR ABANDON}{©USE P.f? ST W ER OR 015POSAL SYSTEM @ $3.017 - _ __.. __—.-._.- --_-_ _...._-_._- _✓ _. STATE ENOR ' PER .. .. A ...✓^ - tNDUSTRIAL WASTE APPROVAL PERMIT CHARGES OWNER'S PERMIT Q•-cw -- - ---- -- — -- --- -- --- -- -- — --- -- -- AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE ! HAVE AT THIS DATE A CONTRACT WITH. THE HERF'IN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EX!$TING DWELLING TC l"HE PU 13 LIC SEWER. APPROVALS _-.- DATE 1 INSPECTORS SIGNATURE SIGNED TF91S--- DAY OF--------'f�3__� ----- _ -_- _--'----�------ OWNE:R OR NEW HOUSE SEWER OW NERS AGE NT -•---" CONNECT ADDITIONAL, 1 BUILDING OR WORPC--_-___-) _�_____ --. -. _-- SEPTIC TANK,SEEP,PIT(S -�'--.--__-__ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS. APPLICATION AND/OR DRAINFIELD AND 5TAT'E 'THA-, THE ABOVE 15. 'ORRECT ARID AGREE. TO COMPLY -i---- WITH .ALA. COUNTY ORDINANCES AND 5TATE. LAWS REGULATING PLU M2i ING AND SEW E:R.S. CESSPOOL ❑ GRYWELL HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR _- -"-- - - L'eCENSED A5 REQUIRED BY LOS ANGLES COUNTY AND STATE OF .%SWAGE DISPOSAL.SYSTEM 1 CALIFORNIA OR `THAT I AM THE LEGAL. OWNER OF.. AND INTEND TO DJSCONNEC'T PLUG AND - RE51DE IN, THE ABOVE DFS R;BED RESIDENTIAL PROPERTY.� ABANDON {OUSE SEW ER SiGNATU RE ,y%�. - y BACKFILL SEPTIC T ANFCS OF PERM!T7EE,_-. OcgP.PITIS) L�, CESSPOOLS (7� V,ALII)ATION ROBERT A. WOOD M.U. CASH SUPERVISING ENGINEER Yy