HomeMy Public PortalAbout6247 SULTANA AVE_Sewer__ -E808 10-C2
XEIA642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION
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JOHN A. LAMBIE. County Engineer A 0 D R ES S
WILLIAM A, JENSEN, Sup't of Building
LOCALITY
NEA E E.
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FOR APPLICANT TO FILL IN I'DSsS
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LOT N10.
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41
MAIL
-BLOCK TRACT ADDRESS
NO OF BLOGS
S17E OF LOT NOW ON LOT j I CITY TEL. NO,
USE OF
BUILDINGSBY
DISTRICT NO. GROUP MAP
BK PG PROCESSED
CONTRACT
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CONNECTION DATA
trySTATION DEPTI.4
L. NO.
_
�TATE
-AII-CIE.REFERENCE
REGJ�TRAT;ON NO. OUNT_
ION OF WORK FEE 'rypt W�v
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NO-
DESC:RIP OF LENGrmFRO
'WER CONN E-C-.j_T N G-rcr------- CURB,� P.L. M.L. r,0 O.L.
'HOUS55E i " I c, "A
PUBLIC SEWER $5,00 Imo-1 '-'
SEEPAGESEPT'rC.54N K, FIT_&R P.0 N-0-
co IMP. JIM
0
N O� 1
PiTS AND'OR DRAINFIELD 510 Do _L_J, NO.
HOUSE SEWER CONNECTING TO
TRUNK PERMIT NO. ROAD PERMIT NO=-,
-
PRIVATE DISPOSAL,SYSTEM @ $3 00
C9dNE .'r /DATE
`
R EASEMENT RFC TW;�
RECORD. I
ADb,TIONAL BLDG.OR _,AwF1I5AV1T �_A_I ve T
_WOR_K_T OI-IOUSE SEWER @__$3.00
OVERFLOW SEEPAGE PIT,DRAINFfELD
FXTfq..CESSf1OC)L_DRYWELL,MANHOLE qV $5.00
- -, __L ___ J__ 'T.WIDENING
ALTER.REPAIR OR ABANDON HOUSE HWY.OR .
SEWER OR DISPOSAL SYSTEM. $3.00
STATE ENCROACHMENT
PERMIT NO-
-T- INDUSTRIAL
WASTE APPROVAL
CHARGES
�
OOWNER'S2
CONNECINON CHARGE FEE
AUTHORIZATION I TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ft1111111$EMENT FEE
TRACTOR CTO R 10 CO;,INECT THE ABOVE DESCRIBED EXISTING DWELLING
PUBi
ro THE __jC SEWER. DATE-�pNSFET.R.,SIGNATURE
APPROVALS
SIGNED THIS__DAY
OWNER OR NEW HOUSE SEWER Stf
Z
OW',IFRS AGENT_ CONNFCTADc_m6NAL
BU I LD1 NG OR WORK
SEPTIC TANK.SEEP,PI T(3)
HERe..SY Ar K04OWLEDGE THAT I HAVE REAP 'T'HIS APPLICATIONAND/OR DRAINFIELD
ANE) STAT' THAT TIHE ABOVE: IS CORRECT AND AGREE TO COMPLY
W1T_,, ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
rLUMRING AND SEWERS, CESSPOOL DRYWELL ❑
IHEREBY CERTIFY
THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR I
LIC
ENSED AS 4EQ0 IRED Ely LOS ANGLES COUNTY AND STATE OF SrWAGE DISPOSAL SYSTEM
CALIFORNIA OR 1HAT I AM THE L EGAL. OWNER OF, AND I TTO U
DIsc0NN5CT FLG AND
T,
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PR7ER Y. ABANDON HOUSE SE-.'.WER
SIGN ATLURE
OF PERMI"I'EF 13ACKFiLLsEpric TANKS 1:1
SEEP,PjT(S) L] CESSPOOLS Fj
VALIDATION ROBERT A. WOOD
C K. M. 0. CASH SUPERVISING MECHANICAL ENGINEER
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