HomeMy Public PortalAbout6035 SULTANA AVE_Sewer__ J
76AS4
7iSAS 42A 2D69 APPLICATION FOS 1 PERMI
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDDRESSG
TORN A. LAMBIE, Countg Enggineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
CROS ,
NEAREST
FOR APPLICANT TO F IN S ST._
LEGAL '
_ DESCRIPTION LOT NO. ds' �� ,yr'�r $sem OWNER 'w.
BLOCK TRACT «-^y. MAIL ! `
;! ADDRESS
N0.6F SLOGS.
SIZE OF LOT NOVd ON LO7 CITY TEL. NO.
USE OF
BUILDINGS D+STRICT NO. GROUP I MAP I PROCESSED BY
BK PCs
CONTRACTOR
i• t 7 ADDRESS CONNECTION CONNECTION DATA
CITY f-J :2 TEL.N L- - STATION SJ p.. - - DEPTH
__ „{ COUNTY —.MANHOLE REFERENCE _.`- `,�4PPER ._..
REG'iSIRATION N0. 9 ;'LOWER
N6 DF,5CRIPTION�F WORK FEE
HOUSES WF R CONNECTING TO
PUBLIC SEWER C`p $3.00 TYPE OF^ �StfAtECTION LENGTH FROM
SEPTIC TAiVK,SEEPAGE P[T UR Y. 1:URB r P.L. M.L.70 P.L. -
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PTT, DRAINFIELD
FKTN._ CESSPOOL. DRYW£LL @ $2.00
P.C.NO.
HOUSE EL DISPOSAL
CONNECTING TO CO,imp.NO. ' JOB NO.
_j PR}VATE DISPOSAL SYSTEM $1.00 _ °ae
-.f--I CONNECT ADDITIONAL BLDG.OR NO,
WORK TO HOUSE SEWER @ $1.00 BUNK PERMIT N0. ROAD PERMIT '� � t
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT rcl
SEWER OR DISPOSAL.SYSTEM @ $1.00 _?ERMIT NO. Q
INDUSTRIAL (j
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 100 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE fLEIMBtURSEMENT FEE
I HAYE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. — ^�-�—
SIGNED THISDAY OF 19s NEW HOUSE SEWER
OWNER OR �- -� CONNECT ADDITIONAL
OWNERS AGENT _EUILDING OR WORK
YrEPTIC TANK,SEEP,PIT(S)
ADDRESS _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ARID STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL E] DRYWELL 0
WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING eL7ER,REPAiR-SEWER OR
PLUMBING AND SEWERS. AETER,PEWAGE DISPOSAL SYR OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR EM
DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA I AM THE LEGAL 6WNER OF THE A VE DESCRIBEAL PERT j EACKFILLSEPTIC TANKS 0SIGNATUR SEEP. PITS) [] CESSPOOLSOF PE
�}n ALIDATION ROBERT A. WOOD
CK. 9.0. CASH SUPERVISING MECHANICAL. ENGINEER