HomeMy Public PortalAbout6136 SULTANA AVE_Sewer__ r DEPART313M OF COUNTY ENGIlU= SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
. COUNTY OF LOS ANGELES BUILDING f/j,
WILLIAM J. FOX. COUNTY ENGINEER I ADDRESS 3 fl'/
FOR APPLICANT TO FILL IN LOCALITY �.
BUILDING NEAREST. +'
ADDRESSn CROSS ST.
LOCALITYDISTRIIIC,T NO. SEWAL NO. PERMITAO.
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NEAREST Ate- ' ✓� 734 /r/SO //_' S 3 6 3 CT 7s
CROSS-ST.
- RECEIVED BY Ready for Inaoeotion DATE ISSUED
OWNER
MAIL .o
ADDRESS USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO:
CONTRACTOR
�ry rte/ �r CO.IMP.NO.AD
ADDRESS if e ��'�+" " c`-�'(/ JOB NO.
CITY TEL.NOVC� v°1 / TRUNK.PERMIT NO.
r �� v TATE '
REGISTRATION NO. T COUNTI�
� ROAD PERMIT NO.
LEGAL / G , STATE ENCROACHMENT
DESCRIPTION LOT N0. 7 PERMIT NO.
BLOCK TRACT ��LryL INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTf�X 3 (/71iOW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO : REIMBURSEMENT FEE
PUBLI'CSEWER @ $ 3.50 ' RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING-TO
PRIVATE DISPOSAL SYSTEM --I.00-
p CONNECT ADDITIONAL BLDG.OR i EXCEPTION RECORDED "
WORK TO HOUSE SEWER 1.00 Q v
ALTER'OR REPAIR.EXISTING NO. I DATE IBY
SEWER OR DISPOSAL SYSTEM .1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
'SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 __ MANHOLE.REFERENCE
UPPER =J LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS. PERMIT ; 1 00 . Y. CURB P.L. M.L.ro.P.L.
AUTHORIZATION TOTAL FEE ®a:l
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 _
1NEW HOUSESEWER
SIGNED TWIS..._._��...DAY'OF......�.__....._.._._...—._.19_�.. -
OWNER OR i CONNECT.ADDITIONAL
OWNERS AGENT......._.._. ..__.......__.._:._._.__..__. BUILDING OR WORK
ADDRESS....................................._.__........___..-.__..-.:_.._......_...... SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT, 1 HAVE READ.THIS•APPLI•' CESSPOOL❑ DRYWELL 0
CATION AND.STATE THAT THE ABOVE 'CORRECT AND AGREE'1
TO COMPLY WITH ALL COUNTY ORDINANCES'AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT 1 AM .PROPERLY REGISTERED DISCONNECT PLUG AND
N
AND/OR LICENSED. AS REQUIRED BY LOS ANGELES COUNTY_ ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM.THE LEGAL OW -•;
ER OF
THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.- BACKfILL SEPTIC TANKS
SEEP.PIT(S)o CESSPOOLS[] x
SIGNATURE •. r�Ti>N�!
OF PERMITTE ___ ___. �_...___._ _ •
7GA642A 663 7/53 -
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
_DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT. TO FILL IN LOCALITY
BUILDING NEAREST ✓
ADDRESS rs { " Iu CROSS ST.
r �r
LOCALITYC mach l DISTRICT N0. SERIAL N0. PERMIT F0.
NEARESTA S
CROSS ST. _ w
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS _ USE ZONE I OCCUPANCYBK MAP PG
CITY TEL.NO.
CONTRACTOR CO.IMP.NO.
F
ADDRESS JOB.NO.
CITY TELAO.
TRUNK PERMIT N0.
STATE
REGISTRATION NO ' n COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
---' PERMIT NO.
BLOCK TRACTa b- INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER $ 3.50 ! I RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIQNAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER t.00
ALTER OR REPAIR EXISTING NO. 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
PITS AND/OR DRAINFIELD 2.00 ( STATION DEPTH
CESfiP00L—DRYWELL I
SPECIAL CONDITIONS ONLY 2.00 1 MANHOLE REFERENCE
ii.t2Eet" LOWER
TYPE OF CONNECTION LENGTH FROM
Y: CURB, F.L.- M.L.TO P.L.
OWNERS PERMIT : � I 00
AUTHORIZATION I TOTAL FEE I -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOWS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS---•- --------DAY OF.- =--•-- ------.------------.!g_.._.':- _ T--- ----J---�--
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.._:....-:-...._. BUILDING OR WORK 1
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--------......__.-------------------- _.....•-•.._..--............ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABfVE,DESCRI13ED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANK$C
S3GNASEEP.PIT(S)0 CESSPOOLS
TURE ;nom
OF PERMITTEE_-_ -• �, ,_ -•---•
�'i 6A642D 663 1/53 •gam