HomeMy Public PortalAbout6355 SULTANA AVE_Sewer__ 7GA042D
:F808.8.58 APPLICATI N F R � ERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS p d _.
CASSATT D. GRIFFIN,Supt of Building LOCALITY
NEAREST
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R APPLICANT TO FILL IN ceoss ST, _.
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LOT N0. ( :3 JT�_ £ "'r`: OWNER
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TRACT r ;Y
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NO.OF BLDGS. — f _
{ s v..,, NOW ONLOTCITY. S;•: I ' .:�-t,U„'_ TEL.N0., c _ ?' DISTRICT AI Q. GROUP MAP PROC.ESSEA BYI
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CONTRACTOR ✓✓ _
ADDRESS CONNECTION DATA Jy
CITY ® `r TEL.N0. STATION q� DEPTH
C" STATE MANHOLE REFERENCE, (TUPPER"b
REGISTRATION NO, 3 1 COUNTY T{XWER-
Nd. I DESCRIPTION CFF WORT{ FEE --
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT 0R --
TYPE OF CONNECTION- ''° LENGTH FROM s ;
•Z,
PETS AND/OR DRAINFIELD @ $3.00 Y. CURB ( P.L. M.L.TD P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 _
HOUSE SEWER CONNECTING TO P.C. N0,
PRIVATE DISPOSAL SYSTEM @ $1.00 _CO.IMP.NO.=/_ JOB NO.
CONNECT ADDITIONAL BLDG.OR
ORK TO HOUSE SEWER $1.00 ;RUNT{PERMIT NO. ROAD PERMIT N0.
W
ALTEWER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SER OR DISPOSAL SYSTEM C $1.00 PERMIT N0,
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OWNER'S PERMIT 2 OD CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE f L REIMBURSEMENT FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECT'OR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. _
SIGNED THIS__--sr I9
DAY OF -;= `'a. NEW Ho13SESEWER
, :
OWNER 6R s ,� i....,_ r CONNECT ADDITIONAL
OWNERS AGENT e
L ' `4 `, �s + _BUILDING OR WORK
-F. F} SEPTIC TANK.SEEP, FIT(S)
ADDRESS ;�,_.� t::. -"�- ,w•' +� F --':.,e: _ ANDrtOR DRFi3NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ---
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY" CE55POOL p 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 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA 'PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE
SEEP, PIT(S) [] CESSPOOLS
- y� J ..f`' -
OF PERM IT—Er
`✓'
r VALMATIO I" ROBERT A.WOOD
CK, x.o. `. CASH SUPERVISING MECHANICAL ENGINFER
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