HomeMy Public PortalAbout6050 SULTANA AVE_Sewer__ ]&E-66f APPLICATION FOR PERMIT. 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County LENGINEER
er
County of Los AngBUILDING
`.�7DRESS_ �. Y ✓-y "r g;:"
JOHN A. LAMBIE, COUNT
Py CASSATT D. GRIFFIN, SUPT LDING LOCALITY
NEAREST �u[.,y q
FOR APPLIC NT _ C?�FILL IN CROSS ST. -> �
2
LEGAL.. .._— --- ----------- =---' _.�_
DE.SCRinTiON OT NO OWNER ��
BLOCK - "CRA.CT „ >, - _ADDRESS -_
NO"OF BLDGS. ' -- .. ,... �_
SIZE OF LOT NOW ON LOT0'&'-
. CITY TEL, N dd
USE OF 1
BUILDINGS '3 ✓ a' DISTRICT NO. GROUP - APAP
FK PG
CONTRACTOR.
ADDRESS '.J, 't s'�...-
had r ; --
CO NV'CTION DATA
STATSN ,: . DEPTH
CITY TEL RIJ./3 e .,✓� �' - -O— # — -- ----- -- — — --- '-
---- MANHOL.E,REFERENCE _
REGISTRATION NO, qq Ll COUNTY
NO. DESCRIPTION OF WORK FEE --- — _— —
HOUSE SEWER CONNECTING TO I _ — Y. CURB .TYPE OF CONNECTION- M.L.LENGTH FROM
+ - �"`�P.L. TO P.L.
1 i U B L i C S L W E R (i7 $3.5 0 `" -- - ---------------
SEPTIC TANK SEE.PACE PIT OR f
PTS ANU R DRAINEIE:LL rt $3.OD
OVERFLOW SEEPAGE PITDRAINfIELD � - P C N0,
_._.._
LXTN ,CESSPOOL,DRYwfELL,MAhdti.OLE $2.00 � _CO,. 1h1P .NO. �_ ,�3 j i0B N'J
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM �c' a':.DO TRUNK PERMIT N0. ROAD PERMIT NO.
' CONNECT ADDITIONAL BLDG,OR STATE ENCROACH AF:NT
1.00 � .PERMIT N0.
! `A'ORK TO HOUSE SEWER .;�ci' c -
ALT R,REPA IOR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM (r- $1.00 INDUSTRIAL
WASTE APPROVAL _.__. ..
CHARGES' - -
I _ CONNECTION CHARGE FEE
OWNER'S PERMIT S i t 1 0
0 --- — --- --------- - — --!
AUTHORIZATION TOTAL �4E_ - r--� 1� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS j DATE IINSP C'TCR'S SIGNAT URE:
TRAC 7H O CONNECT THE ABOVE DESCRIBED = T ------ ----- --- ---�- - - —
,.XISJFdC DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER � -
SIGNED THIS.—.-----DIY 19--- CONNECT ADDITIONAL ..----
O'1'NER OR, _BUIL_DIIIG_OR WORK
OWNERS A.GENTrS ._.i .:---» '_= SEPTIC TANK.SEEP. PFT€;,1--- ----� --------
ADDR L
ZS AND�OR DRAIN£IE
I HEREBY ACKNOWLEDGE THAT I HAVE: READ THIS APPLICATION CESSPOOL[] LRYWELLD
AND STATE THAT THE. ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLESMSING AND SEWERS, SEWAGE DISPOSAL SYSTEM
——i— -
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND i�c?R DISCONNECT PLC AND
LICENSED AS REQUIRED BY 1.05 ANGELES COUNTY AND STATEOF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS�
.y _ .._SEEP.PIT(S)Ll CiSSP001S
SIGNATURE
OF.PERM ITT
----
IOHN A. LAMfBIE, COUNTY OGINEER VALMA`riON ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
A: Id.4, CASH