HomeMy Public PortalAbout6258 SULTANA AVE_Sewer__ CE8
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7f?Att.:U APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING ANIS SAFETY DIVISION 3lI1LnING
JOHN A. LAMBIE, County Engineer A1. s
WILLIAM A, JENSEN, Sup't of Building
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FOR APPLICANT TO FILL IN rROss Sr
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BLOCK TRACEa J �� '� ( 5•
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NO:f'f�F BLDGS. -•-��_,„, _
Si7E OF LOT NOW ON LOT CITY TEL. NO. -"^
LI_;E C F !,✓r ' D STRICT NO. GROUP MAP PROCESSED BY
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CONTRACTOR f f — - '_ _ .-.,7. �•/ .;yY�r
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ADDRESS",�F" ._.„ - �� = '' ., ` CONNECTION DATA
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'j✓� .__ - NTE MANHOLE REFERENCE
L-PPER
REO I57 RA (ONO N f -�..� _ I COUNTY � y y „-V KC1Y3'Ti32.-= ���{q„
NO CLS.0 421E�'1 QN GF WORK --FE. __- -__ TYPE CIP C;N.FxF„C710N LENGTH FROM
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HOUSE SEWER CONNECTING TO - I ,,y/ T _� YC`UCiB P.L. M.L TO P.L. U
^ `PUBLICSEW F R @ $S.00 I ....Flee: - '`--:: -.. --- --- - ---
SEPTIC TANKSEEPAG VIT 0R ,;o IMF, NO ) JOB NO, PR
__ HITS AT$D OR DRAINF(ELD _ @ 410.00 ^. 10-
I HOU9E StrNt"'R COI'dNECTYNC TO TRUNK PERMIT NO. ROAD PERMIT Ntbt',✓ ! L�
PRIVATE DISPOSAL SYSTEM @ 43-00 '
-_
-_
_ CONNECT ADDiT IONAL BLDG DRQ 'y A�"F'1[JA VIT WAIV€it EASEu F. RFCOFD iN Y '•l O.��� DATE
WORKTO HOUSE.SEWER @: $3.00 .- ! /•;,.,s j i 't'
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-PIT.T.QRAINk'tE- -- -
LD -r- -, - z
OVE:RF I.OW'SEEPAGE I 1 � I
{EX N.,C_ESSYOFJL,BRYWELL,MA NHOLE @ ¢5.00
ALTER, HWY. OR ST.WIDENING
SEWER:OR DISPOSAL SYSTEM C $3,OQ -STATE
_ ._.__.�.-.__—x__�..- STATE cNCROACHr,I ENT
I P ERMiT NO.
-- INDUSTRIAL
WASTE APPROVAL
YV 1V ga.LR�7 PERMIT - -- _ CHARGES
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I 2I Op -- — -- -
AV d.S11PS LEATION TOTAL FEE ✓s^�,;?. CONNECTION CLIA HGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REI_MBURSE.MENT F'EE
TRACTOR TO CONNECT Th ABOVE DESCRIBED EYISTING DWEL. ING --- - --OV ---g gq p� �w --- - -
----- ---- --R--
TO THE PUBLIC SrR, •1 _ r'. APPRO VA9Ll 7 DAT 1 7NSF'.E C."COR'b.51C NA7UR=
SIGNED THIS DAY Off_ 19
OWNER OR 6; �r NEW HOUSE SEWER
OWNERS AGENT,._ t• �I x_x!_4..s._.�_. _ -_-_.__-_ pNN.Er'T ADbI'TION A.L
BUILDING OR WOrQK
-------
SEPTIC TANK,SEEP,r'!T 3) t
Y HER
fi:BY ACKNOWLEDGE T�tA I HAVE. READ THIS APPLICATION 'ND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WV9'HALL, C:O N'fY ORDINANCES AND STATE LAWS REGULATING
RI_U NIB]NG AND CESSPOOL DRYWELLCD EWERS. C-1
' HERF'BY CERTIFY THAT I AM PROPERLY REGISTERED AND/'OR ITER,RiPAIR,.SEW ER OR
i.PCIiNSEO AS. REQUIRED BY i.05 ANGLES COUNTY AND STAT: OF SEWAGE D uSAL SY STEt,7
CALIFORNIA OR THAT I AM THE L:G.A[_ OWNER OF, AND INTEND TO ---- --.--.____�-_�-_I_-_�_,__r_—_-__...-___-._-.._.-..-___
R E51DE IN, THE ABOVE E$CRipkb RE:BIDENTIAL "OPF'RTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER i
SIGNATURE
OF' PERMITTEE ) Y /s, '. �J. ^'s;__ BACKFILL SEPTIC TANKS Cf
SEEP,PIT(S1 CESSPOOLS
VALIDATION.--- ROBERT .A. WOOD
�
SUPFRVISiNG MECHANICAL ENGINEER.
CK. M.U. CASH ,:'