HomeMy Public PortalAbout6323 SULTANA AVE_Sewer__ Efl
SaAPPLICATION FOR PERMIT 1
E,&E•E6S Y2�SA
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING-,.
WM.J. FOX, COUNTY ENGINEER ��Dt Ss
CASSAT'T D. GRIFFIN, SUP'T OF SUILDiNG LOCALITY
MOM
FOR APPPCANT T® FILL I
r.. -' CROSS 31.
LEGAL ;; ..J.....� --
DESCRIPTION LOT NO, 1. c_..; d N OWNER
BLOCK TRACT. T j- 1 i c� MAILNO. OF BLDGS.
-. _--^ -�-�• - --- - —--
!..-x ADD c°5
SIZE OF LOT NOWTEL6N LUT.:
USE OF __ _ _ -
BUILDINGS= - DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR i✓y .
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ADDRESS CONNECTION DATA
CITY. TEL. NO STATION e,.,.gi'-, / DEPTH ,✓
--.L,, STATE. IIANHOLE REFERENCE
REGIS RATION NO. D' COUNTY r UPPER `£c77F"ER-
ye � L_
Z 'I - — ' TYPE OF CONN gTI LENGTH FROM ,- '-
No. I DESCRIPTION OF WORK FEE Y. CURB P L.' M.L,TO P,L.
iIHOUSE SEWER, CONNECTING TO
PUBLIC SEWER a_$ 3,50 � {
HOUSE SEWER CONNECTING TO ilf
PRIVATE,DISPOSAL SYSTEM 100 I _ -
��-CONNECT ADDI NONAL BLDG.OR - I j� CO. IMP. NO. �' 3�.; f ,IBB. NO.. `
WORK'i0HOUSE_SEWER
Pa• J'
ALTER OR REPAIR EXlSTIN'`�Y
_-SEWER OR DISPOSAL SYSTEM_ .�-d OD I CR-UNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER I i� ;TATE ENCROACHMENT
AF.C;'OR DIS OSAL S+STE:M 1.00
SEPTIC TANK, SEEPAGE Pff OR -- - 1 'ER SIiT NO. I
f
PIT$AND/OR DRAINFIELD - 2.00 I INDUSTRIAL % -
--
CESSPOOL DR
_WELL - —'� —"- .VASTE oPPROV?L
SPECIAL CONDiTiONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OYh M R'S PERMIT 3 ! 1i OO ---- — — �+----- —
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS - BATE' INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ASOVE DESCR!FED E.KISTING DWELLING - _ _
.q
TO THE PUBLIC SENER
SIGNED THIS—_' _-DAY. OF_-- -' NEW HousE SEWER
CONNECT ADDITIONAL
OWNOWNER AC BUILDING OR WORK
SEPTIC TANK,SEEP, PIT($)
AND/OP. DRAINFIELD
1 HEKEH•Y ACKNOWLEDC.W 'I'AAT I HAVE R'AD THIS APPLICATIONCESSPOOL 0DRYW ELL 0 '
AND STATE THAT THE ABOVE PS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY'ORDINANCES AND STATE LAWS REGULATING .ALTER. REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
F.
I HEREBY CRNFf THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND s`
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALir'ORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL "OPERTY..-- r,. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) ❑ CESSPOOL,r4Y,
_
SIGNATURE -
f .
OF PERMI7T a_
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION
gr BY
DEPUTY DEPUTY
f
EY By b°
DEPUTY DEPUTY