HomeMy Public PortalAbout6161 SULTANA AVE_Sewer__ :E808
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6A642D842D APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LDiNG"
JOHN A, LAMBIE. County En ineer ADDRESSLL- ,/ �-
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WILLIAM A. jENSEN. Sug'I of Builriiag LOCALITY
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NEAREST
FOR APPLICANT TO FILL IN ce93� sT ;-' �_.i -,. q-. ;
LEGAL71
DESCRIPTION LOT NO`'�' 1/, OWNER .Is J
BLOCK TRACT p �l fy MAIL
ADDRESS °
E.�,.
-40.OF BLDGS,
SIZE OF LOT NOW ON LOT CITY w TEL. NO.
USE OF
BUILDINGS ,� >''' - DISTRICT N0. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR '{
ADDRESS C CONNECTION DATA
CITY ' r TEL NO, STATION ; j- ti�.0 z' DEPTH
STATE MANHOLE REFERENCE •" _ ,J' JJPPER
REGISTRATION NO. COUNTY
N9. DESCRIPTIO OF WORKFEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3, ✓
TYPE OJAOR'NECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR
Y. t CURB P.L. M,L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.
OVERFLOW SEEPAGE PIT,DRAINFIELD_
EXTN.,CESSPOOL.DRYWELL @ 52. az
P.C.N0.
HOUSE SEWER CONNECTING TO Co.IMP.Np. . r'.,_ JOB NO.
PRIVATE DISPOSAL SYSTEM @ $1. u
WORK CONNECT H ADDITIONUSE AL BLDG.OR @ $1.001 TRUNK PERMIT NO. ROAD PERMIT N0. '.
SEWER'OR DISPOSAL SYSTEM ABANDON HOUSE @ $1.90 REPISTATE ENCROACHMENT
PERMIT NO. (,)
INDUSTRIAL uj
WASTE APPROVAL y
CHARGES Z
owNER'S PERmrr $1 2100,� CONNECTION CHARGE FEE
TIm
AUTHOR AVON TOTAL FEF. '1 ' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWERr r
SIGHED THIS DAY e�,' 19 NEW HOUSE SEWER
OWNER OR •_ CONNECT ADDITIONAL
OWNERS GENA '� ° ` - ' .BUILDING OR WORK -
4,.
SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY 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 AS REQUIRED BY 'LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER O;_7Ij.E ABOVE
DESCRIBED RESaDENTIAL PROPERTY. e BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S Cl CESSPOOLS
OF PERMITTEE
iLIDATI01�t ROBERT A. WOOD
' tr.o. cAsaa
SUPERVISING MECHANICAL ENGINEER