HomeMy Public PortalAbout6261 SULTANA AVE_Sewer__ 76A642p APPLICATION FOR PERMIT 1
3&E•663 51.55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN _doss STLEGAL
.
—DESCRIPTION LOT NO. 7 OWNER
MAIL d
BLOCK TRACT _ADDRESS-v2 '2
-- � NO OF BLDGS. -- 7
SIZE_OF-LOT� � _y ,y y� ✓. NOW O_N LOT _ ,a.. _ CITY / g � TEL. NO.
USE DDISTRICT NO. GROUP MAF
BUILDINGS _ Y :,� .w:.
—� B PG
CONTRACTOR
-- -- -��y --- - CONNECTION DATA
ADDRESS
�+ : p STATION DEPTH- JT
CITY +� .:., TEL NO.
',,�, .�?,-.HI-.z.'�. ,r'' ,� MANHOLE REFERENCE
r {i.` Qi-'.'STATE LOWER
,
REGISTP NO. �dLj'' i3' [; COUNTY ----- —_ �_-'-- - --
NO._1 DESCRIP110N OF WORK FEE -
I HOUSE SEWER CONNECTING TO TYPE OF FACTION LENGTH FROM y
J a" Y. CURB P L. hi.L.TO P.L.
PUBLIC SEWER C $
SEPTIC TANK SEE'PACE PIT OR
PITS ANDIOR DRAINF1:ELD
OVERFLOW SEEPAGE PIT,DRAINFIELD
P. C. NO.
I EX N.,CcSSP00L,DRYWELL,MANHOLE (k 5 2.001 CO. IMP. NO. JOB-NO.
HOUSE SEWER CONNECTING IO
�PRIVAT'c_DISPOSAL SYSTEM rt S i.00 j �_ TRUNK PERMIT NO. ROAD PERMIT NO.'-,a-
CONNECT ADDITIONAL BLDG, OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Ca 1.00 + PERMITNO.
ALTER,REPAIR ORABANDON HOUSE
� I INDUSTRIAL
EWER OR DISPOSAL SYSTEM rs- $1.00
_.-- — —-- _ WASTE APPROVAL
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00 ----- — - *_— .. . ---- -
-- ---..._-_.--- --- I — REIMBURSEMENT FEE,/ .
AUTHORIZATION TOTAL FEE ,„ APPROVALS
I HAVE AT THIS DATE A CONTRACT WITH THE`HEREI AM CON- DAT'E -fINSPEC7(`R SStGNA7URE
TRACTOR TO CONNEE,T THE ABOVE DESCRIBED EXISTING DWELLINC
---- G- ---- ._—.
70 THE PUBLIC SI_J�r1 �� - NEW HOUSE SEWER _-- ---��_ -- _ -- --- __---
$Iti14t;D THIS�.�DAX._Q 1` CONNECT ADDITIONAL. j
OWNER OR
BUILDING OR WORK j
._ — -- -----I---.-- ------'
OWNERS AG N'L_...._
_ _ --• SEPTIC TANK,SEEP, PIT(S)
ADDR.5' _. � ''f- - V s AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE 10COMPLY
CESSPOOL C� DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALDER,REPAIR,SEWER OR
PLUMBING AND SEVIERS, SEWAGE DISPOSAL SYSTEM 1
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORSCONN£C7 PLUG AND
__.—�_._-----------
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
DI ��-----��-----._..---
CALIFORNIA OR THAT AM -Hk LE�G,4L OVJ R OF ;THE AB01 -n ABANDON HOSE EWER I- -
ESR jL' RE _UXAV PROPER '�' I ,qr�^ ,,��++^^-- BACKFILL SEPTIC TANKS
¢A�L7 �' �+' �' V' ✓L SEEP. PIT(S) D CESSPOOLS U
0' PERMITT
E *'
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
:ASH