HomeMy Public PortalAbout6278 SULTANA AVE_Sewer__ 16AG42D APPLICATION FOR PERMIT 1
3&£-663 11.55
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING,
ADDRESS``
JOHI�! A. LAINIBiE,CouN7v ENGINEER —�•'- "�
J CASSATT D. GRIFFIN, SUPT of BUILCIrIc LOCALITY v
Ft APPLICANT TO FILL IN _CRpss
LEGAL �/C J r ` OWNER
DESCRIPTION LO_T NO. jygy.
�. MAIL
BLOCKTRACT - "y
ADDRESS
Y
LD G
SIZE OF LOT ;.�� • NOWNO, OONBLOT R^: :. CITY
USE OF r'
BUILDINGS .� „{�..._ DISTRICT 9,6. GROUP MAP
BK PG
CONTRACTOR C/t � •°9,Sv.. SSSS - r - �'
. TCONNECTION
ADDRESS �+ P t,�y'. ..�d' T✓, [.��'..y=g -..� SSSS -- --- --
CITY i<w^;a�"d,` ,a.,y�+.T�„ � TEL. OJ „2� --- STATION . -�� _- DEPTH
MANHOLE REFERENCE
— STATE
REGISTRATION NO. ;'� ` "� `� COUNTY --_� '- - ---y- �
NO. j DESCRIPTION OF WORK FEE - TYPE OF } E_CTiON LENGTH FROM
—
--- -- -- -- --'- --
l j HOUSE SEWER CONNECTING TO ! - .M Y ��RB P.LTO P,L.
.. M.L. -
PUBLIC SEWER @ $3.50 j ..,,'
—'- — — Ir
SEPTIC TANK, SEEPAGE PIT OR
-j PITS AND/OR DRAINF19LD ru $3.0o-
OVERFLOW
.0 OVERFLOW SEEPAGE PIT,DRAINFIELD I. P. C. NO.
XTN.,CESSPOOL.,DRYWELL,MANHOLE C $2.00 i CO. IMP NOe + �. ,W JOE NO.
-- -- --- - _.- SSSS--
HOU
SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM D- $1.00 I TRUNK UN_K PE--RMI_T_N-0_..SSSS- ROAD PERMIT
_ PERhtiT N0.
CONNECT ADDITIONAL BLDG OR - ^I
WORK TO HOUSE SEINER (l � � STATE ENCROACHMENT
$I•DO �� PERMIT NO.
--- - --- --- - -�-- -- -�--- - - SSSS-- --
-
iALTER,REPAIR OR ABANDON HOUSE ., INDUSTRIAL.
-
SEWDISPOSAL OR DISPSAL SYSTEM @1.0) _ WASTE APPROVAL
OS —
CHARGES
_ CONNECTION CHARGE-FEE
OWNERS PERINUT— --�� i ---,i 00
------�-i-- --� REIMBURSVMF.NT FEE
AUTHORIZATION TOTAL FEE
I HAVE A7 THIS PATE A CONTRACT W'TH THE HEREIN NAMED CON. APPROVALS I DATE �INSPE.0 rOR _S G.NATURE
TRACTOR T3 CONNECT THE ABOVE DESCRIBED EXISTING GW FEEING
-- -- SSSS-- ---r - - --
TO THE PUBLIC 51R. _ NEW HOUSE SEWER
"` ..- ---—' SSSS ----' - -----�-----
SIGNED THIS' -DAY OF ADDITIONAL - ---
�r 4 CONNECT
OWNER OR6l L DIN OR WORK
OWNERS A fErIT -
p -� SEPTIC TANK,SEES'.PITS?
AND/0R DRAIN IELD..., --�-----'- SSSS ----
I HEREBY ACKNW'LEDGE THAT I AVE READ THIS APPLICATION _L'VS.SPUO L:{]. DRYWELL
O' I G �'^
:AND -STATE THAT THE ABOVE IS CORRECT .AND AGREE TO COMPLY"WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AP1G SEWERS, SEWAGE DISPOSAL SYSTEM -� -
T HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oft DISCONNECT FLU. A Pd D--�� - ----�SSSS--
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE. Of' ABANDON COPSE EWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE Ay,OVE __- O ---
� P � ---
DESCRIBED R N ' ---
'
SIGNATURE SEEP. PIT(S) ❑ ---CESSPOOLS
� pE _. --
OF PERMITTEE ''� °"----- .
`��✓� �
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBE PF T A. WOOD, CHIEF P:UG. INSPECTOR
CK. N.0. rASH