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Home My Public Portal About6241 SULTANA AVE_Sewer__ Aeaab 48 10-62APPLICATION FOR PERMIT �� COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS tig ----- WIT LIAM A. JENSEN, Supt of Building 1 OCAL17Y , h AREST F'OR APPLICATIT TO FILL IN ROSS ST DESCRIPTION — LOT NO, /' f ,.'l, p -_ A r OWNER —C, BLOCK TRAC:, ADDRESS t NO. OF BLD DGS- SIXE OF LOT NOW ON LOT CITY TEL. NO. ll5E OP BU ILDINGS DISTRICT , MAP SK PG ("R UP P C S E 9Y CONTRACTOFipj 4.. ADDftES CONNECTION�DATA --- -- - --- �._-- f `�Y STATION (5 - DEPTH CITY .� ��*� TEL No. -- — - f- - — r — v!•- '` ,,:'9 10 SYATE MA�7'FtiO3 E R:.FERENt;F_'� —� REGISTRATION NO �.:: �' J � rf ❑ COUNTY � � ,._',JP E NO. I GESCRiPT10NF WQK PEE �- ----- ---- TYPE'OF NN CT -4�N LENGTH FRO. HOUSE SEW R:.ONN 4i4 Flv TO T Y- � U M TO I L _- PUBLIC SEWER $5.00 ._— P.C. - --.— ___T— --�- ---- i_� -...? O.— SE C ANK SEEPAGE PIT OR - —i t S AND/OR DRAINF FLD is $10.00 CO TMP NO �s JOB p NOUS SEWER CONN Pia T7i F I_ PRIVATE D!SPOsAL S STt:M TRUNK PERMIT h0. ROAD PERMiT NO`,-; ONNCC`ADDITfONA BLCG OF< �— —AIF-!-DAVIT A!vkI eASk M.€nT 7 RECORD.IIiS7R NO-T DATE I WORK TO HOUSE SEWER @ $3.00 OVE`2FL_OW SEEPAGE PI DRAINFIELD Eh M "ES OOL„DRYWELI.,MANHOLE 0 $5..00_ 1 HWY.OR ST.WIDENING __— , A TER REPAIR OR AB H NOCK OUSE _ SEW R JR OISnOSAL SYSTEM_ @ JSTAVE.€NCROAC`+MENT ----_ —` �_J--- ERMIT NO WASTE APPROVAL : �� ✓ -.. ___._ 1. --- — — 1— -- - ----- — - 0WMR's PERMIT _ 2 CO CHARGES AUTHORIZATION j-TOTAL FEE T `� CONNECTION CHARGE FEE REIMBURSEMENT FEE 1 :HAVE. Al THIS DATE A CONTRACT WITit THE HEREIN NAMED CON- — --.-- —...._.___._.. TRACTOR. TO CONNECT THE ABOVE DE SCRIFEED EXISTING DWELLING --___-_—___ _�9—._ _.-__y c--._._7� i0 THE PUBLIC SEWER. APPROVALS DATE.. -I INSPECTOR'S SIGNATURE SIGNED THIS..�.��DAY 0 --- -- l9-- OWNER ---OWNER OR NEW HOUSE SEWER OW HERS CONNECT ADDITIONAL ADDRESS_ BILDING OR WORK I U_ -'- - -�-- --- ---- — SEPTIC TANK.SEEP.PI<T iS3 I HEREBY AC h NOWLEDGE THAT I HAVE READ THISAPPLICATION AND/OR DRAINFIELD AND STATE THAT THE. ABOVE iS CORRECT AND AGREE E TO COMPLY WITH ALL COUNTY ORO!NA.NCES AND STATE LAWS REGULATING I,L.0 MBI Nie ANC SE'JJERS. CESSPOOLF] GR WELL ❑..—.L,. _— __—.__ - ---.—_. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR I ,_ICL NSED AS R UIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM.? CAL.IFORVIA. OR HAT I aM THE LEGAL OWNER OF, AND INTEND TO RES!OE IN, THE ABOVE, DESCRIBED RESIDENTIAL PROPERTY DISCONNECT PLUG AND _ ABANDON HOUSE EWER �F ^+ � BACKFILL SEPTIC TANKS L OF PtF MITTc — SEEP,PIT lS) IL] CESSPOOLS _------- I "VALIDATION ROBERT A. WOOD C'KM.O. CASH SU-PERViSI-NG MECHANICAL ENGINEER .. 0r r..: 0 . 2, tSEp 1 A64 t°'g2 C 217 FOR OR PERMIT fiA 6x1 COUNTY of LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION [NEAREST UILDING -� ]�'---• j3NN R. LAMBIE, County Engineers DDRE65 -- WILLIAM A. JENSEN. Supt of Building - ---- OCA.LITY FOR APPLICANT TO L INROSS ST DESCRIPTION LOT I,IO 1 y, F: _. OWNER _Y._ r. .'- - •`�rF-;,,, y)- MAIL 3_O.CK TRACT ADDRESS NO. OF EILOGS. SIZE. OF L.OT NOW ON LOT CITY TEL.. NO, SM ILID I NG S DISTRICT NO. GROUP MAP PROCESSED BY - - _-_-_--_ 0-BK PG CONI 4 TOR t-,t � 'A '- 6.� .E _,, a — ADDRE,s CONNECTION DATA _ STATION DEPTH CITY tNOEL STATE f .3:k REGISTRATION NO MANHOLE.REFERENCE "--v OUNTY y 41 - NO 6E S C RI i`TfQN OF INOF�iK FEE LENGTH FiF Rt HOUSE SEWER TONNECT NG TO T r Y C R &L. M.L. TO P P PU HL IC SFWER @ $5 DO ----P.0 NO -- T I - AN SEEPAGE PiT OR _ CO.IMP.NO.. JOB NO. IT.=,qND:OR DRAINF'IELD @ SIO.OLi I Sr.SF WtR CONNE ) NG TO TRU14K PERMIT NO. ROAD PERMIT NO. PRI VATS DI SP SAL 5YSTEM C $.3.00 j C<'NNECT ADDITIONAL BLDG.OR - AFFSDAYIT wAI jj j FASEME`Ei ftECOFf U.INSTR.NO.r DATE _W"111K TO HOUSE SEWER @ 33.00 I I ECO Z I k DRA SEEPAGP! .INFIF_LD I .__l E4TN-.CESSPOOL,Dn'YW Ei L,MA NF40LE ltd E5.00 �_ ----_ ALTER.REPAIR OR ABANDON HOUSE-_ ---___ HWY.OR ST.WIDENING t - - SEWER.OR DISPOSAL SYSTEM -@ 'S 3.00 - _____ STATE ENCROA GHMENT I PERMIT NO. INDUSTRIAL WASTE APPRO VA+ OWNER'S PERMIT s' � 00 ------- --- - ----- ----- —..� — FEE CDI VECTION CHARGE FEE AUTHORIZATION TOTAL I HAVE AT TF DATE A CONTRACT' WITH THE 14.EREIN NAMED CON- HE.IM5URSEMENTFEE - TRAC R YO CO`aNECT THE ABOVE DESCRIBED EXi ST-ING DW..•-LING -- __. _-_ TO T i : PUBLIC .�E`WER. APPROVAL� DATE �INSPECTOR'S SIGNATURE SIGNED T i S DAY QF___�__� �._: OWNER.OR NEW HOUSE SEWER OWNERS AGENT__-_��-_ -.- -- - C7NNE'r7 ADDITIONAL-_ BUiLDI NG OR WORK I -- - SEPTIC TANK,SEEP,PlT(5) � I I H REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR D2AINFIELD AND STATE TRAY THE ABOVE IS CORRECT ANO AGREE TO COMPLY --- - ---- ---------- I j.- ------- .WITH AL COUNTY ORDINANCES AND STATE. LAWS REGUL.ATI NG r PI_UHBING AND SEW FRS, ESS'POOL ❑ DRYW ELL ❑ I}- HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR-,--SEWER CEOR --"_- - ---- ------- _- LIN FD AS REOWRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM _ e ALIFO_.N A OR THAT• ! AM THE LE AL OWNER OF, AND INTEND TO DISCON NE T GAN D - - - _--'--_ R ESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSEEWER SIGtiAT tF_ �' i 5 � '�� BA.CKFILL.S DTIC TANKS 0= PERMITT F:E �- , jj,-s ,f SEP.PITf51 �.J CESSPOOLS VALIDATION ROBERT A. WOOD ff CK.,` M.O. CASH SUPERVISING MECHANICAL ENGINEER 1. 1. 1 r c 7 COUNTY OF LAS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1309090002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: ITR: 5904 IT: 176 1EXIST OCC GRP: I [ 6241 SULTANA AV IBLDGS. NOW ON LOT: I TEMP CA 917801554 (ASSESSOR INFORMATION NUMBER: �1CONNECTION TYPE: I NEAREST CROSS STREET: 15384-005-021 (ORIGINATION: I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl I (LENGTH ML TO PL: STATION: DEPTH: [TENANT: MANHOLE REFERENCE: UPPER/LOWER: JISSUED I 109/09/13N: PROCESSED BY: 1 COUNTY IMPROVEMENT NUMBER: (OWNER: TEL. NO: (PLAN CHECK NUMBER: IF ATE FINAL BY: CODE: I � [ IWONG, VIVIAN (626) 476-3111- IJOB NUMBER: 1 16241 SULTANA AV TRUNK PERMIT NUMBER: 1 I ITEMP 917801554 IROAD PERMIT NUMBER: IDE RIPTION OF WORK I 1AFFADAVIT: NO (SEWER SPOT REPAIR I WAIVER: NO (APPLICANT: TEL. NO: (EASEMENT: NO TRIOS, RUDY (626) 858-9284- I 1475 E ARROW HWY ,RECORD INSTRUMENT NBR: RECORD DATE: (SPECIAL CONDIT NS: IAZUSA (HIGHWAY/STREET WIDENING: I STATE ENCROACHMENT PERMIT NUMBER: I -�j,\3 a ` ICONTRACTOR: TEL. NO: I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE IRESCUE ROOTER (626) 858-9284- 1 1475 E ARROW HWY LIC. NO (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:JNEW HOUSE SEWER I [ IAZUSA CA 91702 765155 I I 01 PERMIT ISSUANCE FEE 27.80 CONNECT ADDITIONAL I I I I 115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 IBUILbING OR WORK I [ I (ARCHITECT OR ENGINEER: TEL. NO: f TOTAL FEES 58.30 1 1 [ I - I ISEPTIC TANK, SEEPAGE PITI I [ LIC. NO: (AND/OR DRAIN FIELD I I IDRYWELL _ SEWER MAP BOOK: PAGE: (ALTER, REPAIR, SEWER OR I [ I ISEWAGE DISPOSAL SYSTEM 1 I I_ DISCONNECT PLUG AND I I I (ABANDON HOUSE SEWER I I I I IBACKFILL SEPTIC TANKS 1S�EP. PIT _ CESSPOOL -1 I 1 IGRAYWATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I i I I I I j I I I I I I I* ADDITIONAL DATA ON FILE [ I I I I I IREPORT ID: DPR266 ROUTE TO BS0508 [ I I I