HomeMy Public PortalAbout6361 SULTANA AVE_Sewer__ rsAE$2� APPLICATION FOR PERMIT 1
i&E-683 9f-55
DIVISION OF BUILDING AND SAFETYSEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS
.JOHN A. LAMBIE, COUNTY ENGINEER
C-A.SSATT D.GRIFFIN, SUPT OF(BUILDING LOCALITY
FO APP A F TQ LL�
NEAREST
ko s sr
LEGALaHOWNER
DESCRIPTIO N� LOT NO. 6MAIL
BLOCK--- TRACT IA�j��� sl% 'lr� 1�A,%d wtw ADDRESS
0.OF ELDGS. ° pq f �J p pig y
" '� CITY }' 9{1:,9.r`�'7, 6h`�C,f=.A_.,e- TEL. N0.e` ,a4.... /��, ,�
Si2_E_OF LOT- "� NOW ON L07 $�' �'
USE OF ---_ t Cy r a - -
BUILDINGSa d J "a0#7,.�. - _. -- DISTRICT NO. GROUP { MAP
BK PG
CONTRACTOR
ADDRESSCON�Ch66_1N7'__i5ATA:___4t__Z_
_
Y
STATION DEPTH
-CITY r....� TEL N0. -
-----_ .----_.e---- _ MANHOLE REFERENCE
�:. J STATE ---------- � � ` --- OYJER_
REGISTRATION NO. L,] COUNTY -
_ c...
No. DESCRIPTION OF WORK FEE_ --- -------
HOUSE SEWER CONNECTING TO - IYPE OF CONNECTION L.
- LENGTH. FROM
PUBLIC SEWER _ C� S�3.50 ` C . M.L.TO F,
��- - ------URB L--- <
SEPTIC TANK,SEEPAGE PIT OR
_'_PITS AND,'OR DRAINFIELD R, $3.00 -
1 OVERFLOW SEEPAGE PIT GRAINFIELD / P. C. NO.
j EXTN.,CESSPOOL,.DRY6VELL,MAN HOLE fu 2.0 _ Co. IMP" NO. p JOB NO.
j
HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM - ( $±.00 I TRUNK PERMIT NO. ROAD PERMIT NO.
I CONNECT ADDITIONAL BLDG.OR —._.._ _ .._..
1 WORK TO HOUSE SEWER cc .ERM(ENCROACHMENT .
PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL - -
SEWER OR DISPOSAL`;YS7E2F7 .----__-- Ca $I.00 WASTE APPROVAL
--�- _ --.- --" CHARGES
I
CONNECTION CHARGE.FEE
OWNER'S PERMIT
--
_ -
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
N--
I HAVE AT TF15 DATE A. CONTRACT WITH APPROVALS CS
EREI — !tD—AT--E—tINSPECTOR"S SIGNATURE
---—_
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -TO THE PUBLIC SEVVEP-., NEW HOUSE SEWER i. I
SIGNED THIS -DAY OF ��a �� � ✓F� t9z --- -------- --<.- _ ._
' CONNECT ADDITIONAL
✓ ,� I'UILDING OR WORK
1
OWNER OR '.^i- --'1..;; y„gym
OWNERS A ENT—.�.. - - - -- — ---___--
'�”+f,'—� — ED/O TANK,SEEP,
� PIT(Si
ADDRESS ^'" � p�!, �.NDIOR D4AINFF'LU
I HERESY AC NOWLED E THAT 1 HAVE READ THIS APPLICAToQN ESSPOOLD DPtWELLC,
AND STATE TH„ .HE ABOVE IS CORRECT AND AGREE TO COMPLY -------�-,_.-------'-----T.-------
VITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR EWER OR j
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HER 'BCERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 ANI THE ,1. ,GA, AWiE4s�j.,F ,l ABOVE
DESCRIBED RE'SIDENT1AL I..-ROPERTY c.,r$. Y ;,. .� '- EACKF L1 SEPTIC TANKS 1 j I i
/'s ��1 SEEP.PIT r i u CESSPOOLS
SIC-NATURE URE � - --- .—.---^ --- •—�—. ---
OF PERMITTEE
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
LK. 21. 0. CASH -