HomeMy Public PortalAbout6125 SULTANA AVE_Sewer__ E-663
ISa E-668 91-SS
APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING ' a
ADDRESS /L
JOHN A. LAMBIE,COUNTY ENGINEER — --- - 1" E--
CASSATT D. GRIFFIN, SUPT OF BUILCING LOCALITY A � �
FOR APPLICANT TO FILL IN CROs 5T. — = f
DE5CRI°TION LOT NO. :-LEGAL OWNER_—
—' ---- MAIL
BLOCK TRACT - ADDRESS
---
NO.OF BLDGS. t __ - -- CITY TCL NO.
SIZE_OF L07 _--.-. NOW ON LOT - - —___-_-
USE OF
. BUILDINGS >' I��., r i y �,-a ' DISTRICT NO, GROUP "I MAP
BK G
— i
CONTRACTOR
ADDRESS --- -- CONNECTION DATA _—- --
CITY at r" '` -TEL NO, __5TAT90N �,, . ..g�•— ----- DEPTH --- - --- —_
MANHOLE REFERENCE
STATE
R E G I ST RAT I(IN NO, i r ., �— (�-COUNTY
rvoDESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING 70 @a — — TYPE OF CONNECTI LENGTH FROM ,
i. $ 3..5'0
(
Y. CURB 1rP L_--- M L TO P.L. ^�
—�. i PUBLIC SEWER _.. _. - --------- -- --_
SEPTIC TANK SEE=PAGE PIT OR
PITS AND/OR DRAINFIELD <y $9.00
0 V ERFLOW SEEPAGE-PIT,DRAI NFIELD
EXTN. CESSPOOL DRYWELL,MANHOLE al $2.OD I - CO.�1MP NO, __c JOS N0.
—.— —.
-_IHOUSE SEWER CONNECT]NG TO
PRIVATE DISPOSAL SYSTEM c2. $1.00 I RUNK PERMIT NO --- ROAD PERMIT NO_.� � t' .�
CONNECT ADDITIONAL BLDG OR --- ,5- STATE ENCROACHMENT -- --- .
-- �- WORK TO HOUSE SEWER _ n $i.OD I _a+ _.. _PE_R_MIT NO.ALTER,REPAIR OR ABANDON HOUSE I T INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (Ki $1.00 I' WASTE APPROVAL --
CHARGES
CONNECTIONCHARGE FEE
VW
ONEWS PERMIT $ 1 00 ----�_
.p. REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
i i
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE
INSPECTOR SSiGNATURE;
TRACTOR TO CONNECT TI:E ABOVE DESCRIBED EXISTING DWELLING
TO T:k PUBLIC EVER, NEW HOUSE SEWER
�I---
SIGNED THIS ° DAY OF
EROR CONNECT ADDITIONAL '
OWNER -: _ BUILDING OR WORK I
OWNERS AGENT S� '-- --------PJT(S) - --
: �--! SEPTIC TANK,SEEP.PJT(S1 `--- '
ADDRESS_ AND/OR DRAINFIE'LLi
9 HEkEBY ACKNOWLEDCE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TOCOM-PLY CESSPOOL( DRYWELL❑
WITH ALL COUr41Y 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 A5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF AgkNpON HOUSE SEWER —i--
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES1DECdT1AI» PROPERTY. ' - BACKFILL SEPTIC TANKS❑ -
SIGNATURE SEEP. PIT(5).O C _S POOLSQ'__j ,---_--._
OF PERMITTEE
i
IOHN A. LAMBIE COUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLI3G. INSPECTOR
CK. M.0, CASH 4