HomeMy Public PortalAbout6049 SULTANA AVE_Sewer__ r
8608 8.so APPLICATION FOR PES MIT ',,
COUNTY OF LOS ANGELES SEWER-SEWAGE D SPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADIDRDE S t
IOHN A. LAMBIE, County Engineer '
CASSATT D. GRIFFIN, Supt of ,Building v.
LOCALITY �-;d>.•' -
NEAREST , - '
7
FOR APPLICANT TO FILL IN, CROSS ST,
LEGAL 7 h
_DESCRIPTION LOT N0. ,yy L yy,%y�ty OWNERBLOCK TRACT � 0—® MAIL
B
�, r -. ADDRESS
440.Olf BLDGS. l
SIZE OF LOT yI NOW ON LOT CITY TEL. NO.
USE OF 1
BUILDiNG5 `��-r- �yy "' '� DISTRICT NO. GROUP BK MAP PG pR�I,CESSP BY
CONTRACTOR
' CONNECTION DATA/
ADDRESS
CITY . TEL.No. , l0 DEPTH
'` ❑ STATE M NHOLE REF'ERENC'E
REGISTRATION N0--- - ❑ COUNTY ;;� ,;- n LOWER
No. DESCRIPTION OF ORK EEE --
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER $8.0� TYPE OF CONNECTION �-LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD C+B 58.00 -
OVERFLOW SEEPAGE PIG,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00 f1"'-.. .
rHOUSE SEWER CONNECTING T9 � CO, IMP.N0, �f� � JOB N O
PRIVATE DISPOSAL SYSTEM $1.00
CONNECT ADDITIONAL BLDG.OR - ,d ,'J;+'
WORK TO HOUSE SEWER C-'+ SI.00 "TRUNK PERMIT NO. ROAD PERMIT NO. ! �r� ��p�,y✓i�.
ALTER,REPAIR OR ABANDON HOUSE _STATE ENCROACHMENT
9 I
SEWER.OR DISPOSAL SYSTEM @ 51.00 _FERMIT NO.
" INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT fc CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRAC% A CTHE ABOVE DESCRIBED EXISTAS DATE CONTRACT WITH THE iING DWELLWAMED ING TO CONNECT NG APPROVALS DATE (INSPECTOR'S SIGNATURE
TO THI PUBLIC SEWER.
SIGNED THIS DAY OF'" 19— NEW HOUSE SEWER
OW14ER OR CONNECT ADDIT30NAL
OWNERS AGENT_ ��- BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRY'WEL.L I3
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY HAT I AM PROP�.LY' REGISTERED AND!OR -
LICENSED AS REQUb�ED BY LOS ANGELE COUNT'Yi AND STATE OF DISCONNECT PLUGG
AND
CALIFORNIA OR AAAT I AM THE LEGA OWNS THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RES XT'fAL PROPERTY. l /,+ BACKFILL SEPTIC TANKS ❑
SIGNATURE `_:'�f. `C-'{� A Ls - SEEP.PIT(S) [] CESSPOOLS
OF PfERMI7 PP i II
f�
)� VALIDATION ROBERT A. WOOD
CK. M.0, CASH ; SUPERVISING MECHANICAL, ENGINEER
1 I
80a
E808 8s•SS APPLICATION FOR PERMIT
E
COUNTY OF LOS ANGELES SEWER-SEWAGE D SPOSALr 1
DEPARTMENT OF COUNTY 'ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
IOHPi A. I24MBIE, County Engin®or ADDRESS ,( C LtrLL-ec
CAMTT D. GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN r 8 CROSS ST.
LEGAL .*'
DESCRIPTION LOT NO. �L OWNER
BLOCK ,�✓a:�'�` ,/ ^-
TRACT :ms'µ MAIL
TRACT
NO.OF BLDGS.
SPIE OF[OT '
.3 J 0(J.� %' NOW ON LOT C17Y .�_ TEL, NO_
USE OF ,.,.i- -'
BUILDINGS y '� `° DISTRICT N0. GROUP MAF PROCESSED BY
CONTP,ACTOR',-- "" ;.. - - ! qtr {.... .. I .�-K PG In
�- ,✓
ADDRESS W CONNECTION DATA
_
CITY rTEL,NO. DEPTH
REGISTRATION N0. STATE MANHOLE REFERE'NCE� F'� ,`
COUNTY '�j_... K J ��j'
a '• 1 - LOWFR
N0. DESCRIPTION 0 WORK FEE --�-
'
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $8,00 -=
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OZ DRAINFIELD @ $3.00
f OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL,DRYWELL @ 52.00
HOUSE SEWER CONNECTING TO �. P C NO.
PRIVATE DISPOSAL SYSTEM ( $7,00 CO.fMF.N0. r.,�! Jd JOB NO,
i.
✓f CONNECT ADDITIONAL BLDG.OR
v
WORK TO HOUSE SEWER C� $7.00 'TRUNK PERMIT NO. ROAD PERMIT N0. 'LQ'
ALTER REPAIR OR Al ANDE HOUSE STATE ENCROACHMENT
5,_ ER OR DISPOSAL SYSTEtr1 $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
t CHARGES
OWNERS s 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST14G DWELLING APPROVALS DATE I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY.0 19_� _rtEW HousE SEWER
OWNER OR ✓'y ��,J y -CONNECT ADDITIONAL
OWNERS AGENT AGENT- t, l/ 3UILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD I �!
I HEREBY ACKNOWLEDGE THAT IRAVE BREAD THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL D DRYWELL []
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBINGALTER,REPAIR,SEWER OR
.AND SEWERS. _SEWAGE DISPOSAL SYSTEM
3 HEREBYCERTIFY TH T 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRE37Y LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAO WNER OF THE ABOVE -
DESCRIBED P.ESIOE AL PROPERTY.
s'") BACKFILL 5 PTiC TANKS El
SIGNATURE
SEEP. PIT(S) D CESSPOOLS El
�.�-i..- T
OF PERMITTE
)° VALIDATION- ROBE `r A. WOOD
CK. M.0. CASK SUPERVISING MECHANICAL ENGINEER