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Home My Public Portal About6245 SULTANA AVE_Sewer__ .E808 10_82 APPLICATION FOR PERMIT '6A 8426 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING ANIS SAFETY DIVISION BUILDING r* 101" A. LAMBfE, County Engineer AODREsS - � WILLIAM A. JENSEN, Sup'i of Building LOCALITY �✓�v '{_� �.{..___— �..G-F-G, � 'I � _--.— NEAREST FOR ANT TO FILL IN CROSS Sr - - ---__-- nrsc� P QN -Lox NO. p?Y3 -- - OWNER ---CP _BLOCK__ 4 — -- 6 — — TRACT 'j` ADDRESS /3 NQ, OF SIYCOF LOT NOW ON LOT CITY TEL.. NO, U E OF-' G L.D N ,!' DISTRICT NO. GROUP MAP PROCESSED BY — — _ BK PG y" CON"CaACTOR ADDRESS / y) L; - -� "' CONNECTION DATA Z `T - H STATION - DEPTH ,— :C_TY / y_'f ,� TEL NO. __ t°✓ __ �: 7 �` `e �-Y y� DPP REGISTRATION NO ({' /'} rl' ! ❑ STATE MANHOLE REFERENCE NO. 01--COUNTY DFSGR)PT( OF WORK FEE. _ TYPE OP CONNECTIO LENG Fi - ___ —.—_ 'Y}-OUSE SEWER CONNECTING TO Y CU R L M.L TO F.L.°- li V PJBL C SEWER __. —__J._—. _ + ✓ P.C.NO .--I EPTlL'7AN SE EFAc'F P!T qft - CO.fR NOS ~ v ., JOB NO, P TS ANO!OR 6RAINF EL O @ .$10.00 '!' -- -.— — __ — i}LOUSE SEWER.CONNECTING 70. TRUNK P RMil''v0 L ROAD PERMIT NB-.. KI ATL:DISPOSAL SYSTEM $3.00 - r C'�L N>:.CT ADOIT.ONAL BLDG qR l I AF7'I6AVIT i WAivLR I L ASEM ENT RECORD.iNS7R NO.i DATE NORK TO HOUSE SEWER $3.00 I OVERFLOW SEEPAG >l-r,DRAINFIELD — Y LXT!d.,CESSPOOL,PR YN+EL.L..MANHOLE sJ.UO HWY. OR ST.WIDENING SEWER OR D15POSAL SYSTEM @ $3.00 _— _.__ ,___._.. STATE �.&OACH MENT y rf1 PERM 1 _— I - -.� F IINDUST`YftAL V WASTE APPROVAL CHAR ES OVVNEWS PERMIT $ 2: oo — -----— ----- ---- -- ------------ -- ----- ----------- - 4 -- - CONNECTION CHARGE FEE AUTHORIZATION TOTAL. FEE =, ; I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE �' TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXISTING DWELLING TTHE PUBLIC SEWER. -------Al�PilV tlALJ--- !1 DATE' �INSPEGYOft'5 S:GNATU.RE O SIGNED. THIS--- DAY OF,._--- 73__ --- -- --- _.--- -'-_--_—T ---- OWNER OR NEW HOUSE SEWER OWNERS.AGENT,__—. - - CONNECT ADDITIONAL BLIT DING OR WORK AGGRESSLD _ ___ _ C TANK, -- V COMPLY AND WITH DR41NF1 EP PIT(S) _ _I AGGRESSOR A'-K{4W LEO C'E THAT t HAVE READ THIS APPLI ATIf.`N AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO -. --. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGU.L.ATINL', CESSPOOL. DRYW ELL ❑ �--_---�---- PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR I LENSED AS REOU IRED L ALOBY OS ANGLES COUNTY AND STATE OF SWAGE DISPOSAL SYSTEM --{- CIFORNIA R THAT i AM 'THN E LEGAL OWER OF, AND INTEND TO DISCONNECT PLUG AND j REST DF iN, THE ABOVE DE SO RI BED RESIDENTIAL PROPERTY. ABANDON s{OUSE I ,..- .,R SEWS r.__ SIGNATURE 1 OF' PERMITTEE �fy' f. ,+'` BACKFILL SEPTIC ANKS ` lf - 'te-� 'y- Set P,PIT(5J ❑ CESSPOOLS VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER i CK. i hi_O. -CASH t '6A0420 1(-62 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION [LOINS JOHN A, LAMBIE County Fngineer WILLIAM A. JENSEk, Supt of Building .D LOCALITY NEAREST RO 2_1-- FOR APPLICANT TO FILL IN , SS ST. �'- It 41- LOT NO. OWNER DESCRIPTION MAIL BLOCK TRAC-_ ADDRESS NO OF BLDG$. SIZE OP LOT NOW ON LOT CITY TEL. NO. USE: GF BUILDINGS DISTRICT NO. GROUP MAP _:PCESSED BY BK PG CONTRACTOR _ADDRESS CONNECTION DATA STATION DEPTH CITY TEL. NO. Y_ 1� It -__3 STATE MANHOLE RE5ERENCE IN_Y NO. C1 COU T RE GI ST RAGES CRIP-rior, oF_woR-K____ FEE TYPE OF CO NECTIO LENGTH F. 4 HOUSE SEWER CONNECTING TO -R ia M.L.TO P2 0 PUBLIC SEWER @ $5.00 PC.NO. }SEPTIC TANK,SEEPAGE:PIT OR _-- JOB NO. CO. PITS AND/OR DRA114FIELD $10,C)o99 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $9 00 TRUNK PERMIT NO. ROAD PERMIT NOrlz 0 CA INS DATE C_ONNECTADbMJONA BLOG.OR AFFIDAVIT [Wimi! PiECORD� I WORK TO HO "SES EWER @ .$3 00 OVrRFI._OW SEEPAGE PIT,DRAINFIELD EXTN_CESS POOL.D RYWE7L L.MAN H OLE @ $5.00 HWY.OR ST.WIDENING ALTIEW,R—EP—AIR OR k-BANDIDNI 7 SEWER OR DISPOSE L SYSTEM @ $3.00 STATE-ENCROACHMENT PERMIT No. INDUSTRIAL WASTE APPROVAL CHARGES OWNEXPERS MIT CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I .:�� 1*C _- -- --- I HAVE AT THIS DATE: A. CONTRACT WITH. THE HEREIN NAMED CON- RE I.8 U R 5 E_tE.N T FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EX15TING DWELLING To THIS p US L rC SEWER DATE INSPECTOR'S SIGNATURE APPROVALS SIGNED THIS___._LAY OF ,___l OWNER OR NEW HOUSE SEWER OWNERS AGENT—___ CONNEADDITIONAL ADDRESSBUiLDJNG OR WORK SEPTIC TANK,SEEP,PIT(S) IHERF5Y ACKNOWLIEDGL THAT I HAVE READ TWS APPLICATION AND/OR DRAINFIELD ANDSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU Me!NG AND SL:WERS. CESSPOOL i:1 DRYWELL E:! I HEREBY CERTIFY T14AT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED By E.AS REQUIRED LOS ANGLES COUNTY AND STATOF SEWAGE DISPOSAL SYSTEM, CALIFORNIA. I ALIFORN A OP. THAT I AM THE LEGAL OWNER OF, AND INTEND TO �N�E6' R — PLUG AND I EDE IN 7HE ABOVE DES CRISED. RESIDENTIAL PROPE AN HOUSE SEWER SIGNATL RE BACKFILL SEPTIC-TANKS— OF P" RMITTIE SEEP.PIT(s) 0 CESSPOOLS VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER SCK. W O. CASH 7.0 0-