HomeMy Public PortalAbout6138 SULTANA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
•DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FII�L IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY S
NEAREST — ----- A
CROSS ST. 4 ='`LA '
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCYBK MAP PG
ADDRESS
CITY TEL.NO, h
CONTRACTOR' CO.IMP.NO. -
ADDRESS JOB.NO.
CITY TELAO. TRUNK PERMIT NO.
CI STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL $ a STATE ENCROACHMENT
DESCRIPTION LOT NO V24 PERMIT PERMIT NO..
BLOCK TRACT INDUSTRIAL
j ---- WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT '
USE OF CONNECTION-CHARGE FEE
BUILDINGS _
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
I PUBLIC SEWER _ @ $ 3.50 RECEIPT NO. i DATE IBY
¥ HOUSE SEWER CONNECTING TO E
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITI6NAL BLDG.OR EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00 I N0. DATE (BY
4i:TEF(bFt REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
j SEPTIC TANK,SEEPAGE PIT OR
_PITS AND/ORDRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRY.WELL MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.60 I MA :;rr 3 LOWER_
1 TYPE OF CONNECTION LENGTH FROM
-r. CURB -'r. M.L.TO P.L.
OWNERS PERMIT $ 1 1 00
AUTHORIZATION TOTAL FEE
1 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
SIGNED THIS-- DAY OF _ .--... i�-:�:. NEW HOUSE s£w£R
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT.,..--..::'- .................
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-------..__... -- - - AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
A,ND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKS
SEEP.PIT(S)r] CESSPOOLS[3
SIGNATURE —
OF PERMITTEE -.-.:-;-_...
76A642D 663 1/53 .. f`