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HomeMy Public PortalAbout6317 SULTANA AVE_Sewer__ '$AE-66 APPLICATION FOR PERMIT 1 S&E-868 tf-58 - - DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 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 FILA. NEAREST _ CROSS ST,LEGL DESCRIPTION' 6T' O. .`. OWNER MAIL BLOCK TRACT .ADDRESS - NO,OF BLDGS. SIZE OF LOT NOW ON LOT - --- CITY TEL. NO. USE OF DISTRICT Ntl. GROUP BK MAP BUILDINGS CONTRACTOR. ' •.: ADDRESS _i CONNECTION DATA ` STATION DEPTH CITY_J/, L. NO. MANHOLE REFERENCE � STATE --- - - '--y-•f--: '-.r.�i., �i.OW�A REGISTRAT2' N � 7Z9Com" ❑ COUNTY No.T DESCRIPTION OF WORK F- — -- — _r - — _--- '- '---- - —'-- - TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO PUBLIC SEWER _ _ @ $$3.50 --Y- CURB_ _.I.-. M. TO P,L. I SEPTIC TANK,SEEPAGE PIF OR -j- PITS AND/OR DRAINFIELD ce $3._00 OVE. OW SEEPAGE PIT,DRA1NFiELD I P. C. NO, EXTIV.,CESSPOOL,DRIWELL,MANHOLE fcg $2_.00 I CO. IMP, NO, JOB N0. HOUSE SEWER CONNECTING TO -r---- i PRIVATE DISPOSAL SYSTEM fct $I.00 I ( TRUNK PERMIT NO. ROAD PERM]T-NO, CONNECT ADDITIONAL BLDG.OR - ---------------- WORK TO HOUSE SEWER ,r, STATE ENCROACHMENT $1.00 I PERMIT NO, _ ALTER,REPAIR OR ABANDON HOUSE -INDUS --I 1 INDUSTRIAL I SEWER OR DISPOSAL SYSTEM a.. $I. c' WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT - - OTAL I,_ 1 QO T AUTHORIZATION -____FEE. .__ .--- REIMBURS£hIENT FEE 5" I HAVE 5T THIS DATE A CONTRACT WITH THFfl :REIN NAMED CON- APPROVALS ! DATE I INSPECTOR'S SIGNATURE TRACTOR '0 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _ TO 1EF PUBLIC SEWER. - NEW HOUSE SEWER SIGNET?THIS 4W —.DAY OF - CONNECT ADDITIONAL OWNER OR '� BUILDING OR WORK - _ OWNER AGENT ,-r �.L�l�.- "d'.L.�_..-- SEPTIC TANK SEEP,PIT(S) I_ AICD/OR DRAINFIELD ..._. .._..__.�- - 1 hSrATE THAT ,r,AE AB THAT 1 HAVE.C ANDEAL) THIS APPLICATION PLY CESSPOOL❑ DRYWELLI.J AND SYaTE Th,tT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING ALTER REPAIR SEWER OR I I PLUt:xi;[N' AND SEWERS. SEWAGE DISPOSAL SYSTEM f HER CFRTT'Y THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND - CALI OR k4 as G' ;JY d ABANDON HOUSE SEWER._ ._ REQUIRED BY LOP ANGELES COUN AND STATE OF I CALIFC�tNT?. a AT I J'M THF LEGAL (,\' OF T A _6 r _ -__-- €SCRIB R tN�TJ P,$OPcR BACKI ILL SE.T TANKS O - �^ S 4 SEEP, PIT IS 1 CESSPOOLS T T -R14 IT .. sN JOHN A. LAMBIE,COUNTY ENGINEER VALIDATION ;:- ROBERT A. WOOD, CHIEF PL_BG. INSPECTOR GK. m © n -tAA6i -