HomeMy Public PortalAbout6135 SULTANA AVE_Sewer__ !6A84
-8-56 APPLICATION FOR PERMIT 1
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING y
JOHN A. LAMBIE, County Engineer ADDRESS �
CASSATT D. GRIFFIN, Supt of Building LOCALITY
rAEAREST.
FOR APPLICANT.TO FILL IN
LEGAL
DESCRIPTION LOT.NO. <<� 3�c' r7 1�LWNER
BLOCK TRACTMAIL
ti ADDRESS
NO.OF BLDGS.
SIZE OF LOTJ 4 !1 r NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS �s TTAT
N0: GROUP MAP PROCESSED BY
-�-� BK PG
CONTRACTOR—
ADDRESS
nDnREssCONNECTION DATA
CITY y � t - TEL.NO. g.-.rNy- � - 1 DEPTI{REGISTRATEON N0. fLE REFEREN : LOWER,NO. I DESCRIPTION OF WORK. FEEHOUSE SEWER CONNECTING TO
PU_BL1C SEWER @ $3.00SEPTIC TANK, SEEPAGE PIT OR lYPE OF�k#11E IOI+F "LENGTH FROM
[TS`Ahfni4R DRAfNFIEI.,D @ $3.OD iCURB -F P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 t _
HOUSE SEWER CONNECTING TO P. C,NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP,NO. ✓ �� JOB NO.
CONNECT ADDITIONAL BLDG,OR
-�
WORK TO HOUSE SEWER @ $1.00 'TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE tTATF.ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OWNEWS--1 PERMIT 3 ¢ 2 00 CONNECTION CHARGE FEE
AUTHOMATION I TOTAL FEE "0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS DATE INSPECTOR'S SIGNATURE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. t 7—
SIGNED THIS���.DAY OF. �''" 15 NEW HOUSE SEWER ..-
OWNER OR _ CONNECT ADDITIONAL
OWNER SAGENT I.,. ,':e a ��•' '`` BUILDING OR WORK
-- � 4 SEPTIC TANK,SEEP, PITS) -
ADDRESS �` AMD/OR DRAINFIELD _
I .HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL E7 DRYWEL_L[]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
I HEREBY CERTIFY THAT I AAI PROPERLY REGISTE ED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS AELES CQ NTY D STA OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN THE•LEGAL ,6 tIER F :THE BOVE
DESCRIBED RESMN IAL P OPERT 6 i BACKFILL SEPTIC TANKS E l
SIGNATURE- i' ' S;EP.PIT'S} CESSPOOLS"
OF PERMITTEr "
VALIDATION ROE3ERT A.WOOD
1{ CK.,,: V.o. CASH SUPERVISING MECHANICAL,ENGINEER
24650 INSERYS-,, '
76A6
42D60 APPLICATION FOR PERMIT �. . .
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSA :
DEPARTMENT OF COUNTY ENGINEER 11
BUCLDING
BUILDING AND SAFETY DIVISION aDDREssYJ ,. ® .5 C'4 rA IWe3-
IOI1N A. LAMEIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST "
FOR APPLICANT TO FILL IlY CROSS ST.
LEGAL 'y%r
DESCRIPTION L NO. '� OWNER C.s&.r=«�: R••-'–
BLOCK TRACTMAIL w�
+ ADDRESS _
NO'O BLDGS.
SIZE OF LOT NOW ON LOT ^CITY TEL. N'D.
USE OF
BUILDINGS 12. DISTRICT 0. 'GROUPEK MAP P� PROCEStEp�#Y
CONTRACTOR s '-
ADDREssj- -' /.c" — `" CONNECTION DATA
CITY T L.NO. C —STATION DEPT �'"•Ff�, ,1
s
i'- "' [j STATE MANHOLE REFERENCE
REGISTRATION N'. 4 ,,' B'j'� ❑ COUNTY
NO. DESCRIPT(ON_OF WORK FEE ,
HOUSE S::KER CONNECTING TO
PUBLIC SEWER @ S3,00 - - `TYPE OF CONNECTION LENGTH FROM " a'
SEPTIC;TANK,SEEPAGE PCT OR Y. CURB P.L." M.L.TO P.L. z 5..."
ITS AND;OR DRAINFIELD @ $3.00
7,
OVERFLOW SEEPAGF PIT,DRAINFIELD
E.N' CESSPOOL.DRYWEL,L 52,00
HOUSE SEWER CONNECTING TO "� P.C•a
_ Co.IMP. N0. .a J08
PRIVATE OI.,POSAL SYSTEM @ $9.00 •�
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER la $1.00 TRUNK PERMIT NO. ROAD PERMIT NO>:;,r 0
AR ABANDON HOUSE STATE ENCROACHMENT p".
SEW R Oti�..S.EGSA-L SYSTEM @ $1,00 PERMIT NO. Q
INDUSTRIAL +
WASTE APPROVAL W
1.__ .7
. .4 CHARGES -- -
O' R'n$rtr,'- .PERMIT $ 2 00 CONNECTION CHARGE FEE -
AUTHORIZAi N I TOTAL FEE :` REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EMS T
TO THE PUBLIC SEWER. INa DWELLING APPROVALS RATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �� "�"' ✓ t.�V"�-- BUILDING OR WORK I
ADDRESS _ SEPTIC TANK,SEEP.PIT(S)
-- ...--. - AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL Q
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. ALTER,REPAIR,S SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE
EWAG DISCONNECT DISPOSAL
PLUG AND V
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWERD
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESfDENTJAVPROPERrY. BACKFILL.SEPTIC TANKS Q
SIGNATURE SEEP.PIT(S) CESSPOOLS (]
OF PERMITTEE
" VALIDATION ROBERT A. WOOD
CK. if.o. CASH : SUPERVISING MECHANICAL ENGINEEk
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