HomeMy Public PortalAbout6042 SULTANA AVE_Sewer__ ' IJEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY" OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ! BUILDING
f ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST + I� 7 .035> J
GROSS ST.
C,EIVED BY Ready for Inspection DATE ISSUED
OWNERf �
MAIL OCCUPANCY ZONE ONE
ADDRESS I ( BK MAPPG
CITY TEL.NO.
CONTRACTOR CO.IMP.N0. —
`f.
ADDRESS JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
REGISTRATION N0. STATECOUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
— PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER Q $ 3.50 RECEIPT N0. I DATE f SY-n--"`—
HOUSE HEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00_
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0.
DATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 I _ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT QR
_ PITS AND/OR DRAINFIEL_D 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 41ANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS _PERMIT $ 1 I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF..................................------19-------- NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL
OWNERS AGENT...........................................--------.................-------------
BUILDING OR WORK
ADDRESS...........................---•-------•...-•------------------------------...._ SEPTIC TANK.SEEP.PIT(S)
...---••------ AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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 PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LDS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OFPERMITTEE---–-----------............_............................... –
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