HomeMy Public PortalAbout6351 SULTANA AVE_Sewer__ '.76AE4APPLICATION- PERMIT
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DIVISION OF BUILDING ANI; SAF.-'':Y SEWER—SEWAGE DISPOSAL
Department of County Engineer
Countyof Loa Angeles BUILDING
WAR.J. FOX, COUNTY ENGINEER JAID DRE S '�CASSATT 0. GRIFFIN.SUP'T OF BUILDINGLOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL
❑ESCRIPTION LOT N0. --.. ^OWNER �..�
BLOCK TRACT-+".,+r y,>1.4 .. - , MAIL f ..
ADDRESS
NO. OF BLDGS ; --
SIZE OF LOT _ NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS •�_ DISTRICT NO. I GROUP _ MAP
__. --- - — BK PG
CONTRACTOR
ADDRESS ,ay i J - -: CONNECTION DATA
CITY t;r.•i`s - TEL. NO. ....a. >:;. STATION DEPTH
STATE ^_ — M?.n.; . '- REFERENCE M�
REGISTRATION NO. f of COUNTY _ UPP R LOWER_
'�— - TYPE OF CONNECfI� LENGTH FROM
NO. ` DESCRIPTION Or WORK FEES _Y_ C3iRB P._,.___M L TO P,L.
7 I HOUSE SEWER CONNECTING TO
FUEL!C 4EWER it $ 3.50
HOUSE SEWER. CONNECTING TO T�
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 1.00 CO. [MP. N0. JOB. N0.
V _---- N O.
I ALTER OR REPAIR EXISTING Si
E,M_ER OR D9,'�OShL SYSTEM 1 06 TRUNK PERMIT N0, ROAD PERMIT NO.
--
DISC ONNr T AND ABANDON SEWER �— -- -W - - -� �� •��
^� STATE ENCROACHMENT
Qt�D'0 DISPOSAL-POSAL /S-EMS - _ 1.00 _"_ P ZMtT NO
_SEPTIC TANK,SEEPAGE PiT OR
_-- P;T_S ANDi OR DRAINFIELD_ 2.00_' ... INDUSTRIAL
CESSPOOL- DRYrYFLL WASTE APPROVAL
SP CIALCIONS ONLY 9
_._ ONDITON
00 CHARGES
i
CONNECTION CHARGE FEE
O 'EB'S PERMIT j t j co_ _
AUTHORIZATION TOTAL. FEE f REIMBURSEMENT FEE_
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR
ON � ��®gl�+�l�7 DATE fN rEC70R'S 'IGNA.T URE
TRACTOR TO CONNECT THE ABOVE DESCRIFED EXISTING [`1VKLLING
TO THE PUBLIC ,SEWER
SIGNED THIS DAY,OF �Y 19 NEW HOUSE SEINER ,
CONNECT ADDITIONAL
OWNER OR K -') ,'�f BUILDING OR WORK
OWNERS Af,;EN'�,d � „.....
✓,P' S —y„ SEPTIC TAN , SEEP, PIT(S)
��v">/r a.*.1 .�/�z.1..:: .__-____-__--_. _Aiv D_�OR DP,AIYFIfLO
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY —
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/Gk `�--'—`--•—' '-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND. STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERf'Y.
BACKFILL SEPTIC TANKS CI
SEFW. PIT(S) [] CE'SSPOOLS L71
SIGNATURE _.... _ .w_....._.— _.__.__
OF PERMITTEE __ _� 2, -
WILLIAM J.FOX. COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY
(D D€PUTY DF.,PUTY