HomeMy Public PortalAbout6124 SULTANA AVE_Sewer__ 'BA642D APPLICATION ICOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGR
JOHN A, LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
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DESCRIPTION
BLOCK TRACTMAIL
_ ADDRESS
J:
NO.OF BLDGS. '
SIZE OF LOT NOW ON LOT_ _ CITY TEL.N0:
USE OF
BUILDINGS S y '`a3' DISTRICT NO. GROUP MAP PROCESSED 3Y
BK PG
CONTRACTOR ,r �s
ADDRESS r�y> �' �?; L �.r ;s CONNECTION DATA
CITi r y t�, AC TEL.N0. yam.� � " �,� + STATION -' ' DEPTH
" . -4 f STATE MANHOLE REFERENCE tl UPPER
REGISTRATION NO. y ° COUNTY gOW't~R.`
NO, I DESCRIPTION OF WORK FEE _ _
FHOUSE SFWER CONNECTING TO -
PUBLIC SEWER 0 $3_00 3
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
I PITS AND/OR DRAINFIELD ea $3.00
Y. CURB P.L. M.L.TO P.L. i
OVERFLOW SEEPAGE PIT,DRAINFIELD
EYTN.,CESSPOOL,DRYWELL,MANHOLE $2.00
HOUSE SEWER CONNECTING TO d P.C.NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO. IMP. NO. df E JOS NO,
NNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO ROAD PERMIT NO, _ -
WGRK TO HOUSE SEWER @ $1.00
ALTER,REPAIR.OR ABANDONHOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT N0. _
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEWS PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE �' � �� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COPi_ APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLIC SEWER.
SIGNED THIS DAY O,F I g�._ NEW HOUSE SEWER --
OWNER OR ,�,+'' ffr CONNECT ADDITIONAL
OWNERS AGENT_ � BUILDING OR WORK
SEPTIC TANK,SEEP.PITS)
ADDRESS _ 4—_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I NAVE READ TF115 APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP;.Y CESSPOOL 0 DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE 'JF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS
�P SEEP. PIT(S) C CESSPOOLS❑
SIGNATURE
OF PERMITTEE
VAMATIOIJ- ROBERT A.WOOD
CK. U.o. 'CASH - SUPERVISING MECHANICAL ENGINEER
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