HomeMy Public PortalAbout6265 SULTANA AVE_Sewer__ APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
.LEGAL OWNER
LOT NO.
MAIL _.._--
BLOCK TRACT
AD, OF)BLDGS.
SIZEOFLOT _ _ _.NOW ON LOT CITY TEL. N0.
USE OF T
BUILDINGS DISTRICT N0: GROUP I MAP
-- _ --. _-_ ------ --_- i BK PG
CONTRACTOR - -
CONNECTION DATA
ADDRESS - — - ----
STATION _ DEPTH _
.CITY TEL, RIO.- MANHOLE REFERENCE _ UPPER
STATE
REGISTRATION NO. ❑ COUNTY
NO, ' DESCRIPTION OF WORK SLE ---- - --- _`..____�.--------------
-_-� OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO -Y.__-- CURB P.L. M.L.TO P.L,
PUBLIC SEWER @ $ ------ — ------
- -ISPTIC TANK,SEEP I
-_PITS AND OR DRAINFIELDT OR c $,.00 I ---' q -
I OVERFLOWSEEPAGE PIT,DRAINFIELD P C NO.
EXTN.,CESSPOOL.DRY`r ELL,hIANHOLE 42 .--i `CO. INIP. NO. JOB NO.
_ $2.00' _
HOUSE SEWER CONNECTING TO - I
PRIVATE DISPOSAL SYSTEM $9,00 I TRUNK PERMIT NO ROAD PERMIT N_O_._____
CONNECT ADDITIONAL BLDG.OR - STATE ENCROACHMENT
i WORK TO HOUSE SEVER $1.10 � - � PERMIT NO.
..- - -----------
ALTER,REPAIR OR ABANDON HOUSE IIINDUSTRIAL
SEINER OR DISPOSAL SYSTEM (t� $1.iSq--Jt-_-...___-- WASTE APPROVAL
CHARGES
4
_._- --- -_ - _-- --, _...-- CONNECTION CHARGE FEE
OWNER'S PERMIT1 00
�
--- '--- --- ---- RE'MBURSEMENT FEE
AUTHORIZATION TOTAL FEE ( �--
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- J APPROVALS DATE jINSPECTOR'SSIGNAAIURE
TRACTOR T'0 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING T
TO THE PUBLIC rNER. NEW HOUSE SEWER
SIGNED THIS_ -DAY OF__ _____-19._-_- -CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK -
OWNERS AGENT - -- _- .----. --- SEPTIC TANK,SEEP PIT(S)
DR FS AND/OR DRAIN—FIELD.
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL IJ DPYNFLL C
ANDSTA 1'E THAT THE ABOVE ;S CORRECT AND AGREE TO COMPLY _- - -- _ --_
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR f
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM i
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCO-------___-_----------- -------
LICENSED AS REQUIRED BY LOS ANGELES COUNTY :AND STATE OF ABANDON
USESPLUG AND
CALI}-ORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABAN�CN }fOUSE SEWER
DESCRIBED RESIDENTIAL "ii•:TPERTY. - BACKFILL SEPTIC TANKSSIGNATURE
SE P PIT ISL LI CESSPOOLS L
OF PERM CTTEE..—._._.::_.--- -
tOHN A. LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M. v. m ?
DEPART-HENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
` t WILLIAM J. FOX, COUNTY ENGINEER BUILDING
f ADDRESS
' NEAREST APPLICANT TO FILL IN LOCALITY
BUILDINGADDRESS ?-W �+y y�' CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST oFA S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
I
MAIL
ADDRESS USE ZONE OCCUPANCYMAP
BK PG
CITY TELAO.
CONTRACTOR I.�
CO.LMP.NO.
ADDRESS tarn== l
-_-,_ _ JOB NO,
CITY M.0NR0VI.4EIA1#O:
— - - -- TRUNK PERMIT N0.
A 1Onee E Lfjc... STATE
REGISTRATION NO. ."_ R--COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
---- PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT NO.8F BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
f-
.� PUBLIC SEWER @ $ 3.50 +- RECEIPT N0. ( DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00 -
ALTER OR REPAIR EXISTING NO- DATE 4 BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER Lt3WER
TYPE OF CONNECTION LENGTH FROM
OWNERS $ 1 00
Y. CURB P.L. M.L.TO P.L.
PERMIT
AUTHORIZATION I TOTAL FEE ,
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
_
SIGNED THIS.....
.. DAY Rj--- ----. ...........19 NEW HOUSE SEWER
OWNER OR lCONNECT ADDITIONAL
OWNERS A ENT . _ :.. i BUILDING OR WORK
ADDRESS-7�- SEPTIC TANK.SEEP.P—"
� / -- -- rL --- AND/ORDRAINFIELD IT(S) I f
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE L,
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR T AT I AM THE LEGAL OWN-
ER OF THE ABOVJ DES
CRIBED §11DENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE
OF PERMITTEES Y'` -.4. ------
i6A642D 663 1/53