HomeMy Public PortalAbout6112 SULTANA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEVER-SEWAGE DISPOSAL
JtVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
11-ow-"
'WILLIAM J. FOX, COUNTY ENGINEER BUILDING
� ADDRESS -
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS GROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST S
—'—� A
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER _
MAIL OCCUPANCY USE ZONE
ADDRESS �--_ -- I BK MAP PG
CITY TELAO. �.
CONTRACTOR
---_ - .- ------------- CO.IMP.NO.
ADDRESS
JOB.NO.
CITY ---- TEL.NO. i TRUNK PERMIT NO.
[)
REGISTRATION N0. STATE
E3 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT -
PERMIT NO.
BLOCK TRACT .. INDUSTRIAL -
f WASTE APPROVAL
SIZE OF LXT, NO.OF BLOCS.
- NOW ON LOT CHARGES
USE OF
BUILDHNGS CONNECTION CHARGE FEE-
NO.T DESCRIPTION OF WORK. FEE REIMBURSEMENT FEE
e£- HOUSE SEWER CONNECTING TO
`' PUBLIC SEWER_ 0 $ 3.80 RECEIPT NO. � DATE �BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
—' CONNECT ADDITIOkAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DlSCONNECTAND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 J CONNECTION DATA
SEPTIC K,TANSEEPAGE Pit OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
A CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
LOWER
TYPE OF CONNECTION LENGTH FROM
7 CURB P.L,- M.L.TO P.L.
OWNERS PERMIT ; I 00 —
AUTHORIZATION TOTAL FEE I —
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
SEPTIC TANK.SEEP.PIT(S)
ADDRESS-------------•-----.... ..------ ....................... .._..... .. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL El DRYWELL Cj
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE _
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS 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 E]
SEEP.PIT(S}� CESSPOOLS I 1
SIGNATURE 1
OF PERMITTEE.. ------ ------ ------_----- I!
76A642D 663 1/53 ��
DEPAILTBU&NT OF COUNTY ENGINEER L SEXIER--,SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY +. PERMIT APPLICATION
COUNTY OF LOS ANGELES
-
FOX,, COUNTY ENGINEER BUILDING
ja
WILLIAM J /
- '` I ADDRESS��1 � � ���/��,�f
FOR APPLICANT TO FILL. IN LOCALITY '�!-
BUILDING (' •NEAREST yam''
ADDRESS .II �J ,d �G� CROSS ST. ,%5
LOCALITY DISTRICT-10. SERIAL NO. PERMIT N0, c
NEAREST
CROSS ST.
RECEIVED'B�. Ready for Inspection DA ISSUED,
OWNER
MAIL t
ADDRESS ,sem- USE ZO v- OCCUPANCY BIC M P PO
CITY � TEL.NO. /'�/ ���iG��
CONTRACTOR CO.IMP.NO.
ADDRESS 3 JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. ® COUNTY- ROAD PERMIT NO.
LEGAL �- 3 2 : STATE ENCROACHMENT, - —--s
DESCRIPTION LOT AIG. /��• PERMIT N0.
BLOCK TRACT• !)��� � ' wASTSE APPROVAL t
SIZE OF LOT ��.�. j NO/W�ON LOT
� � CHARGES
USE OF C- JJ y / .CONNECTION CHARGE E
BUILDINGS J,tsw.,.e��, K �/rtr4e iLC/ft/ I
NO. DESCRIP171 OF WORK FEEf REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 8.50 RECEIPT NO. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /EXCEPTION RE DED
WORK TO HOUSE SEWER 1.60
ALTER OR REPAIR EXISTING 7N—0. 1 DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
.DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR -•��•r�
PITS AND/OR DRAINFIELD 2.00 STATION / / y -7+ 7 DEPTH
CESSP00 L—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER.
TYPE OF CONNECTION LENGTH FROM
• OWNERS PERMIT I 00
.AUTHORIZATION TOTAL FEE
1 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
—. �R
OWNERS AGENT. ___..... / � BUILDING OR WORK p G1W 'P �tJ
SEPTIC TANK.SEEP.PIT(S)
__..�._....__.._....___._._._.„. AND/OR DRAINFIELD
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
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED.;' DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY,', ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE.LEGAL OWN-0
ER OF THE ABOVE DESCRIBED RES ENTPROPERTY. BACKFILL SEPTIC.TANKBC
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE.?.d—._—Xi...A�--.._.._.._._�._..,._-•--- ._.e
76A642A 663 7/53