HomeMy Public PortalAbout6329 SULTANA AVE_Sewer__ --7'
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GA642 D • APPLICATION FOR PERMIT
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COUNTY'OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
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JOHN A. LA BIF;, County Engineer �N �✓r�����r�
GOL.F:'.fAti W. JE1KfNS, Jup't. of Building
ice - T—yyy�rLr -ITYSTFOR APPLICANT TO FILL IN ST. Ave„
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DESCRIPTION LOT NO. �.-,+. -"/ .!-" "'S OWNER
L =--
MAIL
BLOCK TRACT �p�7 �, ADDRESS .f In
NO, OF BLDGS. 97—1 r
SIZE OF LOT NOW ON LOT CITY �� TEL. NO. 6 J [,/
USE OF —
BUILDINGS_ � ,� !_,r'✓L. ��-� DISTRICT NO. GROUP C
MAP PROCESSED BY
S
8K PG. _
CONTRACTOR
ADDRESS CjO ECTION DATA
-- -`- STATIONDEPTH _
CITY TEL. NO..
LIFE N5E LICENSE MANHOLE REFERENCE ✓ f UPPER
N0. CLASS _ '
NO. DESCRIPTION OF WORK FEE_�i TYPE OF CONNECTIO --..� LENGT FRO"
`
HOUSE SEWER CONNECTING TO 5.001f`'G Y. CURB P.L.; M.L T P.L.
U6L!L" SEWER V
-T3�E'P71C TANK, EEPA GE PI? OP. 4 f /I P.C.NO. �-
PITS AND iOR DRA!NFIELD C $10.001 I CO. IMP. NO. ! - ( JOB NO.
MOUSE SEWER CONNECTING TO ~�u TRUNK PERMIT NO. ROAD PERMIT NO. U
PRIVATE DISPOSAL SYSTEM $ 3.00;
.i CONNECT ADDITIONAL DG. OR AFF IDAYIT WAIWER EASEMEx=N.1.. NO. DATE
WORK TO HOUSE SEWER $ 3.00OF .4A8NPON HOUSE ____
I SEWER OR DISPOSAL SYSTEM " $ 3.004
CO'p�'r�'EFpq�E--p7T-6R7SF'px7E[(T— — HWY. OR ST,WIDENING
EX TN.,CESSPOOL, MAN'!GI.E - $ 5.001 STATE ENGROACH MENT H
PERCOLATION TEST $ 5.001 PERMIT NO.
-------------------- � — INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT _ $1 21 00 —
I ,— CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE � �''d� -- ---- ----
'I HAVE AT THFS DATE A CONTRACT WITH THE HEREIN N MED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER yy E
DATE INSPCTOR'S SIGNATURE
SIGNED THIS ypDAY OF _79 -
OWNER OR NEW HOUSE SEWER
OWNERS AGENT-7/I CONNECT ADDITIONAL
`y'�.yT� BUILDING OR WORK
-- ------ --- _-- SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ---
WITHALLCOUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MSING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEVER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
GALIFORNIA OR THAT I AM THE LEGAL WN€R OF, AND INTEND TO DISC 4N NECT PLUG AND
RESIDE IN, THE A'OY'E UES RIBED R �i ENT!AL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS [�
OF PERMITTEZi
❑
--- — —" —'------" SEEP.PIT IS) U CESSPOOLS
VALIDATION
CK. M.O. CASH
Lg 7 3 u�i JULP u D 7.00