HomeMy Public PortalAbout6158 SULTANA AVE_Sewer__ 'DEPAlhTvE@NT OF COUNTY ENGINEERSEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY - PERMIT APPLICATION -Ilk
COUNTY OF LOS.ANGELES ° BUILDING � 1
WILLIAM J. FOX, COUNTY ENGINEER �I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY cz-.I
BUILDING / a� NEAREST
ADDRESS - 1 U/T,�fj A CROSS ST.
LOCALITY _ DISTRICT NO. SERIAL N0: PERMIT NO.
CROSSST. � _ �/ � .4
RnCEIR CEIVED BY . Ready for lospeot.Ion DATE ISSUED
VED BY
OWNER
MAIL USE ZON OCCUPANCY MAP
ADDRESS BK PG
CITY TEL.NO: ..I _ J
CONTRACTOR 14 CO.IMP.NO. I�$��. -2—G
ADDRESS r n� ,�_q. JOB NO. -
r
CITY TEL.NO. G TRUNK PERMIT NO.
REGI TRATION NO. 4-7 V AVCOUNTY; ROAD PERMIT NO:
s s i
LEGALGG STATE ENCROACHMENT �—
DESCRIPTION LOT NO,�_ �` G� PERMIT NO.
BLOCK TRACT (9 P ,� .WASTETRIL
APPROVAL
SIZE OF LOTjq(33 N W N LOTS CHARGES
USE OF
BUILDINGS r-.���/ /z.��(^ CONNECTIO RGE'FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
SEWER 3 3.50 RECEIPT N0.-�I DATE-`I BY
HOUSE `
HOUSE SEWER CONNECTING TO r
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 0
ALTER OR REPAIR EXISTING NO. I 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 .,�R DEPT
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHO.,LE-REFERENCE
--UPPER �a.• LOWER
TYPE.OF'CONNECTION LENGTH FRO
Y.-- CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 00 \ �'
AUTHORIZATION TOTAL FEE zoo
I HAVE THIS DATE CONTRACTED WITH 'THE HEREIN NAMED
CONTRACTOR TO CONNECT,THE ABOVE DESCRIBED EXISTING APPROVAL'S INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS____..._DAY OF.. .�._— ._.19_�.. NEW HOUSE SEWER
OWNER OR COCT BUILD NG OR WORK
, OWNERS AGENT.............................._._.._.......__........_.._._ '
EPTIC TANKSEEP.
ADDRESS...............--•---.._._._.,.._.__._:._.............---....._.•--.__.___.
AND/OR DRAINF ELD IT(8)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- , CESSPOOL DRYW ELL
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 1 AM PROPERLY REGISTERED ° ' DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY L08 ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT t AM THE LEGAL OWN-
ER OF THE ABOVE DESC IBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE 1 SEEP.PIT(S)[] CESSPOOLSE]
G•( 1� -
OF PERMIT
T �'� ....�..___.._..__.._.._._... .-_---..
76A642A 663 7/53 (Jl