HomeMy Public PortalAbout6345 SULTANA AVE_Sewer__ �sAsaaa APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMMIE, County Engin®or ADORESS -�
CASSATT D. GRIFFIN.SuP't of Building LOCALITY _
NEAREST �
FOR APPLICAN'� TO, Ilej cRQss sr 4 '
DESCRGP ION LOT NO LEAL __.AAs OWNER ' t
BLOCK TRACT 1 MAILADDRESSy
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SIZE OF LOT NOIR ON LDT S
_____ CITYTEL, NO. k
USE OF
BUILDINGS ' r,= .. ,` )DISTRICT NO. GROUPI MAP PROCESSFO B
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CONTRACTO 4 f t Mj d -'N,
ADDRESS 2 ,' s ,�' ; , r r C NNECTION DATA
CITY ;"': - Ahl- } TEL N0. �. ">T STATION �� DEPTH
STATE >UPPER�
REGISTRATION NO. _ COUNTY MANHOLE REFERENCE
NO. DESCRIPTIO NIIOA FEE — f +L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 L•''
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION ,. LENGTH FROM
PITS AND/OR DRAINFIF.LD @ $3.00 Y, CURB 'P.Ly M.L.TO P.L. - -
OVERFLOW SEEPAGE PIT,DRAINFIELD --_'.f
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2,00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM $I,0'0 C_0.Ph1 P,N0, t., JOS NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 _
ALTER,REPAIR OR ABANDON HOUSE `STATE E�CROA�RxENT�-__ _
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT N0. �J
.. INDUSTRIAL -'"•� -- -"
WASTE APPROVAL
_ CHARGES
OWNkw PERMIT $ OO CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _
TO THE PUBLIC SEWER.
SIGNED THIS - --DAY OF---19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEIj"a—�� .-.._,.... BUILDING OR WORK
SEPTIC TANK,SEEP,PITS)
ADDRESS �'-teL ami AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY C: SSPDOL a DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A THE LEL OWNER 4f THE ABOVE
DESCRIBED RESIDENTIAL-PI}G3-JwRTY �"sA ✓ BACKFILLSIGNA`IS s
,..L P (° k u€ Iv r ] rESSP00LS L
OF PERMI*EE
EDF VALIDATION- -.-.. R.OBERT.A..WOOD
CK, U.p, CASH SUPERVISING MECHANICAL ENGINEER