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HomeMy Public PortalAbout6203 SULTANA AVE_Sewer__ :E808 10-6z$ APPLICATION FOR PERMIT -"- " *As42D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL !a DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING r} JOHN A. LAMBIE, County Engineer ADDRE C)s 2p WILLIAM A. JENSEN, Sup't of Building NEA-REST FOR APPLICANT TO FILL IN CROSS ST. - _ D-.: R Pl'CM. .7T ND MAIL BLOCK TRA(:T '� _ � �a ADDRr SS N0. OF ELDGS. :_ SIZE Or OT NOW ON LO7 "-� CITY TEL. NG. JSE 01" - _ BJIC.D1Pd 5 D:STRIC:'T NO. GRO:J P MAP PROCESSED BY __CONTRACTOR_ 4' r` A"J 5-5 sl ADDRESStd _ ry /- /,�''"'` CONNECTION DATA • __._ ..-_ L �✓ STATIONDEPTH 11.4. �• _�y+✓.-�..� L Na._t 1 7 .aJ �f- TIONO ( '3 ✓ ,� r c' MANHOLE REFERENCE REGISTRAN L� __,. ^� � OU N7v III t'<•a LOWER NO. j GESR I PTo OF' WORK- FEE - TYPEOFCONNECTION LENGTH FROM HOU O:f SEWER CONNECTING YCURBP. M.L.TO P.L. PUBLIC.`EWER $5,00 I ... -___.._ -.. - P.C.NO. - S -P-IC 7r'�h S €PAGE PIT - u Ot$ � � "O IMP NO. JOB NO. I FITS AND,.rR DRAI.FI F:E,L`J 01, $90.00 I I ..___-- tj jTRUNK PERMIT NO. ROAD PERMIT NO. PRIVA �'DISPOSAL SYSTEM 53-OD f"ONNE T f DDITfO JAL SLD OR 1 --� �—� AF"IDAVITwMVER [ASPM{NT�-- RECORD INSTR NO.�— DA.TE� Q _i WORK TO HOUSE SEWER _ @ _,03. N i OVERFLOW SEEPAGE PIT,DRAIN FI FLO '� 5E{d R OR CI�PO�'AL SYSTEM. `�.__-_-- � E'>;TN c'- SPGC'4,DR WELL.MANH(^LE - _ e _ $5:C0 A3. ER.F?.PPAIR Ok ASA NGON H.aU E --�-- y-'`��'�tl.�_ � E $3.DO ! _._- �- ._. -.-_ - _._ .. SFAT£EN CRVA..NMENT ! PERMIT NO. I INDUSTRIAL I WAST,APPROVAL --,._.. CHARGES OV,FNFR`S PERMIT - �P- --2' oo --_- - ---- ----- -- ------- ----TOTAL ._.._.__-_ ., CON^d Ec'T!ON CHARGE Fr_E AUTHORIZATION TOTAL FEE_ A J ,fit d-�� _-- -----.__ ----- ----------- —MNS _-------- BUR.a€ E 'I NAVE AT THIS DATE A C--TRACT WITH THE HEREIN NAMED CON. REIM-___._.._ YRACT-)R TO CONN-ECT THE ABOVE DES"CRi9ED EXISTING O'WELLiNG _..__ -__ TO THE PL1BL1 ScWFR. APPROVALS DATE INSPECTOR S iGN.4TURE 51GNED THIS —DAY .-_-- -__---- OW NER OR NEW HOUSE SEWER — J OWNERS AG'--NT___-_.__._ CONNECT ADDITIONAL � 81J Ii.DING OR WORK I SEPTIC TANK,SEES.PIT(5) 1 HFR_R•Y ACKNOWLEDGE THAT I HAVE READ T'HI5 APPL7..ATiONI AN G!OR DR AI N.FIELD j AND STATE THAI THE ABflOVE 15 CORRECT AND AGREE T7 COMPLY WI'`H ALL COUNTY ORDINANCES AND STATE LAWS REG;JL.ATjNG I PLUMBING AND SEWERS CES'POO [] DRYWELL D 1 HEREBY CERN Y THAT I AM PROPERLY REGISTy Rfib AND!OR ALTER, FAIR SEWER OR L CENSFD AS REC3ldIR£D V' x35 AN 5 C-7U N7" AND sT.ATE OF EWP.GE J SP�S.AL SYSTEM ._ALIFORWA. OR THA AM 77+1E LLQ C::W NFR 0�, AN❑ INTEND TO —_ ._- DSC OIaP tCT Fi_UC AICD P.E-51DF :N, THI A6` CE. P ��r, SID N A` YRaP RT Y. /"?"" ABAP•i00`v HOUSE SEWERSIGNATURE j BACKFIL SEP TANKS ! OF PERMtTTE _-.- _ '_� -- - SEEP.PIT(S) J CESSPOOLS []' _. I.IDATION, ROBERT A. WOOD crc. M.o. ASH SUPERVISING MECHANICAL ENGINEER �i�e