HomeMy Public PortalAbout6358 SULTANA AVE_Sewer__ 1
a 6-663 77.55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY' SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ;
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS-
CASSATT D.GRIFFIN, 5UP'T OF BUILDING LOCALITY -
NEAREST �+.
7BLOCK
S APP AN O FI CROSS ST s
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LOT N +W`ILI& .. ,wYd' , � L+? _OWNER _- �,: y F ..' : _-'1'' ,0 _ t. .:. .
TRAC HAIL
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a `+ N0.OF BLDGS, ----�f-
S1ZE OF LOT I p � W QN LOT CITY TEL. NO. "5 ' ¢• a a.`j41
USE OF
BUILDINGS °� .c x . ' .c a - -_ - DISTRICT NO. GROUP i MAP
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CONTRACTOR '
1ADDRESS
CONNECTION DATA
CITY _ - TEL.NO.t „F' ` -f ->' DEPTH
MANHOLE REFERENCE _ - UPPER
P R` 7
STATE
REGISTRATION NQ. , El COUNTY u
NO, DESCRIPTION OrWORK 'FEE
HOUSE SEWER CON NI! - .. _ TYPE OF CONNECTI .IV--., LENGTH FROM .
- PUBLIC_SEWER n $3.50 I �` -Y-= --CURB_ P Ct; M,L,TO P L. � v
SEPTIC TANK,SEEPAGE PIT OR - _ -- —_--
--- -PITS AND/OR DRAINFIELD_----- (ai- $3.00 - —
OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. NO, _
EXTN_CESSPOOL.DRYWEL_L,MAN_HOLE Q $2.00� � -CO, IMP NO, _ P.
NO. �-
I MOUSE SEWER CONNECTING TO
__PRIVATE DISPOSAL SYSTEM $'..00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL.BLDG,OR -T- - --- STATE ENCROACHMENT --_-- - - --------�
j WORK TO NOUS.E SEWER -fief $1.00.
_�--. - -- PERMIT NO.
ALTER REPAIR OR ABANDON HOUSE - - --- --------- - ---�------
I SE YER OR DISPOSAL SYSTEM n 1.00 INDUSTRIAL
---:..-_—.- ---- --. $ _. WASTE APPROVAL
' - - CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT_ _ $ t oo — --- - - --
-'-a REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE `" ? '
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE fINSPECTOR'S SIGNATURE
-
.- --G --
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC $EWER, r NEW HOUSE SEWER r
SIGNED THIS---7,-DAY OF �19r-� CONNECT ADDITIONAL
OWNER OR �` ' BUILDING OR WORK -�
OWNERS AGENT ''�:;r
- � SEPTIC TANK,SEEP,PIT(S)
ADDRESS ,�..B� 'jl AND,/QR CRAiNF1EL.D .-- r_ ---' ----
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL( LRYVELL L � I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ____ -__-____ ------
—_
WITH ALL COUNTY ORDINANCES AND STATE LALVS REGULATING ALTER,REPAIR,SEWER OR I I
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM C
I HERE3Y CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON
AND i
ABANDON HOUSt SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE - --- ---- -�- -----�- -------
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS FJI,
SIGNATURE / :> SEEP. PITS) 0 CESSPOO S(
OF PERMITTEE
JOHN A. LAMBIE,COUNTY ENGINEER VALID .TIO ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CA. N.O. r CASH