HomeMy Public PortalAbout6314 SULTANA AVE_Sewer__ 75A6420
$ E-663 B-S5
APPLICATION FOR PERMIT i.
$
DIVISION .OF BUILDING AND SAFETY SEWER-SEWAGE DISPOAL
Depcstment of County Engineer Bv1LDING
County of Los Angeles
AIM.J. FOX.COUNTY ENGINEERs-
CASSATT 0.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
_
CROSS.ST, ✓ r,-•:_! �.
LEGAL
_DESCR(PTiON _LOT_N0._ OWNER �r/� ;._,;,,_ ;'. . •�BLOCK TRACT TRACTS MAIL
_ ADDRESS ,J.y, _
NO. OF BLDG
SIZE OF LOT NOW ON LOTS CITY YTEL, 10,
USE OF
DISTRICT NO. � GROUP NIAP �
SK Pu
CONT
ADPR _ CONNECTION DATA
CI. - �_..� �. TEL. @' STATION _ .. DEPTHi—^-�.
F11 STATE MANHOLE REFERENCE __
UP
0
ER
REGISTRATION NO. s [I COUNTY
L. M_ TO P.L.O. DESCRIPTION OF WORK FEE
H01J5E SftidER CONNECTING TO �a .:e>> TYPE OF CONNECTio' _ LENGTH FROM
' Y_ CURB P L.
.__PUBLIC SEWER - @ $_-3.50
'"�' - _._ .._
—HOUSE SEWER CONNECTING TO�--i ^ -- ---
_ PRIVATE DISPOSAL SYSTEM 1.00.
CONNHOUSE
ECT ADDITIONAL BLDG.OR T P C. NOi
SS
_ ORa TO HOUSE SEFJL' 1:00 CO. If'P_N0. 1J8 NO.
ALTER OR REPAIR EXISTING - --- ---_ - --- - --�_-
Sc'JS'EK_t.R_DIS.P_OSAL SYSTEPd 1,00 TRUNK PERMIT NO. ROAD PERMIT NO.
—. ...).
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/ORDISPOSAL SYSTE_N_ 1.00 SER ffi1fT N0.
SEPTIC TANK, SEEPAGE PIT OR� —}
PITS AND/ORDRA.INEIELD 2.00 --INDUSTRIA.L - 01�-- 19
CI°SSPOOI DRYlYELL
-- -- - WASTE APPROVAL e
SPECIAL CONDITIONS ONLY 2.00 CHARGES
_-SPECIAL
--'— ---� --I—�
CONNECTION CY.ARGE FEE_v_
OWNEWS PERMIT 5 11 00
AUTHORIZATION TOTAL FEE 'b RILpdPUR5FMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN -AMFD CON-
TRACTOR TO CONNECT,THE ABOVE DES�PIBED ISIING
DWELLING _ L APPROVALS
DATE INSPECT Z'^a SIGNATURE�
TO THE PUBLIC SF,r3 � J —---- -._— _—_
SIGNED THIS��.DAY 0 ' " 3D NEW Hous_SEWER
OWNER �r CONNECTADDITIONAL
O'w4EPS G"NI� / BUILDING OR PORK 111
'�_ - •-. •�- f :y,! .f �... .t�C., � SEPTIC TANK, SEEP, PIT(S) .�._.
AND/OR DRAiNFIFLD�� _
I HEREBY ACKNOWLEDGE THAI' i HAVE READ THIS APPLICATION CESSPOOL F DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR, 5£4YFR OR
SEWAGE DISPOSAL SYSTEM
! HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR ---�"--""'---`-- -- "' --
UCENSED AS REQUIRED BY LOS ANGELES.-fi UNTY AND STATE OF DISCONNECT PL13G AND
CALIFORNIA OR THAT i AM THE LEGA' NER OF THE ABOVE _ ABANDON HOUSE SEWER
DESCRIBED R SIDEXTIAL7K�
BACKFILL SEPTIC TANKS CrEEP.P!T(S) [�} CESSPOOLS[fSIGNATURE
OF PERhiI-or
11WILLIA. J.FO]C,COUNTY ENGI EER VALIDATION R.A.WOOD, CHIEF F�LBG. INSPECTOR