HomeMy Public PortalAbout6121 SULTANA AVE_Sewer__ r®a -66
Ets.s3 APPLICATION FOR PERMIT 1 _
s�
DlVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS
JOHN A. I,gR�IBIE, COUNTY ENGINEER _
C� CAS.SATT D. GRIFFIN, SuP'TOF.cutL.DING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN OR
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LEGAL ��w �
DESCRIPTION Lo oC aWNFR ..,I�',.t ,. d6.
BLOCK TRACTADDRESS
NO
SIZE OF LOT _. J .FsIf NOWOONB_LOTS ----^-- ,. a
CITY ,,.�', .G4.'4a &.F�,. TEL. NO
B U�LDINGS °` -i' _" 6"`" DISTRICT NO. - GROUP ( MAP
BK PG
CONTRACT'0___, `'�3 ,•d`&� 4 Y ��� '' -: '-- _ 4`_.-� P. . l .�_ .�1_-�___
ADDRESS CONNECTION DATA --_-- —
- — _. _
�7�-� p`y / - _STATION _. �J� _ _ DEPTH - � /-. z•-
CITY -S - _-- TEL NO. f ._. � .,__ MANHOLE REFERENCE -_- s ER
T ,r _` `..
rr .. j�� STATE ___ ___ c. :b � ,. •LCs11Ei2:..
REGISTRATION N0. ----�- ."`=-z --�-=COUNTY --
No. jDES�.RIPTION C1F WO FEE _ _ -------- ------- -- -- -----T
- ---- - - TYPE OE-C�ORWECTION LENGTH FROM ✓
HOUSE SEWER CO.NNLCTING TO - ,i f -V
si-p-r C_ EWER .. a>. b ��.,50 Y, CURB P.L.- M.L.L-TO P.L.PL +k ----_
I - - - — --
SEPTIC TANK SEEPAGE P1T OR
PITS AND/OR DRAINFIELD ai $S.0^ - -- -
__---f -_.--- -_.._ _-.--.-
oVERFLOW EEPAGE PIT, DRAINFIELD 151
I EXT-N_,CESSPOOL,DRYWELL MAF HOLE a CO. IMP. NO. ` _ ` JOB NO.
HOUSE SEWER'ONNECT NO f0 z-, f
g 1,0p TRUNK PER
PRIVATE MIT N0. - ROAD PERMIT NO. .
DISPOSAL SYSTEM_ ca _ _.,. _._ .
CONNECTADDITIONAL BLDG.OR Y � STATE ENCROACHMENT
_,I_WORK TO HOUSE SEWER _ _-__-Cca $1.00 I. PERMIT
ALTER,REPAIR OR ABANDON HOUSE
,
-AASr TRIAL
SEWER------_� SEER OR DISPOSAL SYS T E.,M _--__.__C_�.1_00 _-- __.._ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
Owii�ER S PERMIT I 00 ---- ----- ------ —
- - -
REIMBURSEMENT FEE
TOTAL APPROVALS DATE -{'I
INSPECTOR SSIGNAT-W2
IRCONTRACT H THEREIN NAMED Ox _.----
TACTOR
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �
TO THE PUBLIC �VJ47 NEW HOUSE SEWED
SIGNED THI,13--!L--<"_.�Z—__DAY OF * )g_ f_
�-- CONNECT ADDITIONAL
OWNER- OR s4 ,r9,� A all`/+ ' BUILD N OR WORK �
OWNERS AGENT. :7 9., = r x :A.^P, �J �.. d,-rt. ._-
�-+� -;� -- SEPTIC TANK,SEEP,PIT(S) �
ADDRESS- f � ✓�Sg*�!'' -'`T.. -- AND/OR DRAINI IELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL L] DRYWELLEj
AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR I PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM.
I HEREBY CERT'F'Y THAI I AM PROPERLY REG ERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELE`,'-COU AND STATE OF I
.f- ABANDON HOUSE EWER_
DESCRIBED
OR THA
PM RHE LE A. W •R OF THEalE - - -- - -- -' -.
DESCRIBED RFSIDENTi PROPERTY 4 �;, 3ACKFILL SEPTIC TANKS L]
., .� SEEP,PIT IS) 0 CESSPOOLS LJ I I
Sif'NATURE z -- - -- -----� - -._.
OF PERMITTE --
JOHN A. L.R HII GqU ENGINEER LIDAd 3Y®I _a ROBERT A. WOOD, CHIEF PL@G. INSPEC'T'OR
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