HomeMy Public PortalAbout6264 SULTANA AVE_Sewer__ A86420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
NG
JOHN A. LAMBIE, COUNTY ENGINEER SS: '
COLEMAN W. JENKINS, SUPT. OF BUILDING
ITY __ �.t- • - _.L_
F APPLICANT TO FILL IN(PRINT ^JR Tv E CNLY) ST._
LEGAL—
DESCRIPTION._ _LOT'NO. - OWNER_!✓.
..-_ __ __— MAIL
BLOCK TRACT r ADDRESS � -
NO, OF N BLDGS. ""
SIZE OF LOT NOW ON OLOT �y CITY-11 ":a:,y, r,'"-- TEL. NO. -
USE
DISTRICT N0. GROUP CLASS I MAP yPR CE55E BY
LDINGS
BUI __ BK PG
-
CONTRACTOR' �';f L-:,L fC.�i3 it�
ADDRESS.,.'.*.�;r.... .>' �p - { � >,., ?-- ,''L" CONNECTION DATA ----
/ STATiON DEPTH
CITY L f i� , �_vc/�� TEL. N0. ��-- / '� 4 ' �✓�
STATE / LIC
LICENSE_NO; -�,J.7 i..'.� CLASS r ' 1.,,er MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK. FEE _ e EN
_ TYPE O `+ T1AN LENGTH FROM
J HOUSE SEWER CONNECTING TO - /,t: Y. CURB P.L. M.L.TO P.L,
Pi18lIC SEWER $5.00 ---'— "— -"-'
y SEPT iC TANK.SEEPAGE PIT OR ! ry �•>;�`4c P.C.NO.
CO. IMP.NO. 1 /eL,.�E JOB NO.
PITS AND OR DRAINFIELD $10.00 - - —
HOUSE SEWER CONNECTING TO
---_- -- -—_---- �- --- --- LL �°
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE.DISPOSAL SYSTEM _ @ $3.00 (�
-{II-CO'4NECT ADDITIONAL BLDG' OR AFFIDAVIT wAIYER fAs[M[NT RECORD. INSTR.NO. PATE�—
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN,.CESSPOOL,DRYWELL.MANHOLE @ S5.00 I —� PP�qq,,
---�----- ----
ALTERHWY. OR ST WIDENING 0
,R PAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT
_ -
Lu
I
PERMIT NO. a-
__ INDUSTRIAL V)
II WASTE APPROVAL Z
CHARGES
OWNERS PERMIT--- ----$ -- ao ---- ---- —
AUTHORIZATIONJ TOTAL FEE & i".P.__ CONNECTION CHARGE FEE
I HAVE AT 'THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING --- —
TO THE PUBLIC SEWER✓ APPROVALS DATE INS ftl-TOR'S ffiI G NATURE
SIGNED THIS .`'r�� DAY OPs:'`- -- --
OWNER OR t v? NEW HOUSE SEWER.
OWNERS AGENT yr_� ✓`^.; _ 5Y _ .. _
_ - CONNECT ADDITIONAL
BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT HAVE'READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(5)
AND.%OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ .
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR —
LICENSED AS REQUlREO`T3Yy,3 LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM4,THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ,�g,BOVT• ESC IBED RF.51�EN IAL PROPERTY.
,pisi ABANDON HOUSE SEWER a
SiGNATUfi'!'OF PE'f3,p� ^�_ y_ 6�=ms's:-&`dam._._ BACKFILL SEPTIC TANKS ❑ 'g 1 y�1�
--�` SEEP.PIT(S) ❑ CESSPOOLS ❑ !1+t'7*)�) FF^�r.� ,y�--
VALIDATION_-..:, JACK R. ALLEN
CK. M. CASH
SUPERVISING MECHANICAL ENGINEER
O�'.