HomeMy Public PortalAbout6201 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 ENwNErR BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL N0. PERMIT NO.
NEAREST A I S
CROSS ST,
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
I BK PG
CITY TEL.NO.
CONTRACTOR
--- CO.IMP.NO.
ADDRESS
JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. H COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
-- — PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. <
NOW ON LOT — _ CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO.I DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
`PUBLIC SEWER a $ 3.50 I RECEIPT NO. ( DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
4WOPCOII3
NNECT ADDITNALLD
BG.OR EXCEPTION RECORDED
.K TO HOUSE SEWER 1.00
ALTER OR AI
REPR EXISTING NO DATE 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
,PCESSPOOL-.-DRYW ELL
ECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
- UPPER LOWER
_ TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT = I I oo_
AUTHORIZATION I TOTAL FEE i
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED APPROVALS INSPECTOR'S SIGNATURE DATE
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINEi
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...........--..-DAY_ _.._DAY OF..-....--.................................19.-...... NEW HOUSE SEWER_ _.�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT......_..._. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS................---..__._.--._.._...-......-------...................._.__•-•-----------_. AND/ORDRAINFIELO
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL n
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
AND/OR LICENSEDAND
� AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
PLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS
SIGNATURE
OF PERMITTEE- ---------------------- -------- ............._........... - -
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