HomeMy Public PortalAbout6326 SULTANA AVE_Sewer__ 76A542r) APPLICATION , FOR PERMIT.
6 3 E-d63 12.54
DIVISION OF BUILDING AND SAFETY SEWER-SEW O E DISPOSAL
I)ogoatmeat of County Engineer
County of Los Angeles B is ILD I N G
WNI. J. FOX, COUNTY ENGtiINEER A;sDRESS
CAS$ATT D. GRIFFIN,SUP-T OF BUILDING
LO"ALdTT
3
FOR APPLICANT TO FILL IN doss sr.
LEGAL
DESCRIPTION LOT 14
fT
OWNER
... NER
BLOCK TRACT 'S MAIL
'. _±(
NO.,OF BLDCS _
SIZE OF LOT t,,.r�•� `1 /._�' NOW ON L07
CITY TEL. NO-
_—,
USE OF -
BUILDINGS DISTRICT NO. GROUP MA?
SK PG
CONTRACTOR �_.� .—__.___._, ! •~ i __ ..
ADDRESS CONNECTION DATA
CITY .•,V�:-.... TEL. NO, :RTlON :u•., 'p� a DEPTH-
y
❑ STATEAN
HOLE REFERENCE
REGISTRATION NO, y°� F� ��'` �` '" ✓❑ COUNTY _�._+ F ' _I UPPER �.,•
' — TYPE OF CONN CTI LENGTH FROM
No, DESCRIPTION OF WORK FEE _}'•. cuR6 P.L.) M L.TO P,L. "
— HOUSE FEWER CONNECTING TO
PUrUC 5EWER `G' $ 3_50 ,r✓ a,
HOUSE SEWER CONNECTING TO
PRIVAT DISPOSAL SYSTEM 1.00 — - ----------
f CONNECT ADDITIONAL BLDG. OR CO. IMP,NO. JOB. NO
WORK TO HOUSE SFW_ER_ 100
ALTER OR REPAIR EXISTING I
SEWER OR DISPOSAL SYSTEM I.00 I T'�UNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER --- STATE ENCROACHMENT
_I
AND/OR DISPOSAL SYSTEM_ 1.00 j FER 6`T NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINF E D 2.00 )' 1NDUSTRIA
{ CESs POJL ORi Ll _— — — --`- VA.,TE APPROVA-
SPECIAL CONDITIONS ONLY 2.00 I I GHAR,G•E'S°
CONNECTION CHARGE
OWNER'S PERMIT On _ — —---
AUTHORIZATION TOTAL FEE � ,, I j j 1 RrIMBURSE FEE ,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECIOR'SSiGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
70 THE PUBLIC SEINER
NEW HOUSE SEWER
SIGNED THIS ;•✓ DAY OF 2
OWNER OR CONNECT ADDITIONAL�•//,d s �.,/,� ,'' g/ /,�✓ s BLILDING
OWNERS AUENT .t,s_i..e=.. 3�
SEPTIC TANK SEEP,PIT(S)
ADDRESS_._ `YiT r -= c. __-+-Y r AhD10R DRAINFIEI.D
_v _ .
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL fl DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .....,.._..._.—. ..._.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS.
SEtrAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND%OR —'— - �"------
..-...__..._..._._.__�_..._.. _..
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE AB:`,NDON HOUSESE"::ER _
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[3
J SE_C_P. PITS) 0 CESSPOOLS[I_
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
BY ,. .1 SAY .. - ,. ..
DEPUTY {.<r� DEPUTY
BY O trf
DEPUTY DEPUTY