HomeMy Public PortalAbout6368 SULTANA AVE_Sewer__ 9EAE-66 APPLICATION ION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS --
CASSATT U. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS sLEGAL
T,.
DESCRIPTION LOT NO ". OWNER
BLOC —TRACTsy�n_ ' J ' MAIL . p`�s�-� tpr feAf.�
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SIZE OF LOT �..., �,a.{..: ,t' NOW'ON LOT s�9 CITY TEL. NO.
USE OI' _ � --
BUILDINGS iiP"[ _'_.�•""' ,,'_•f DISTRICT NO. i GROUP - I MAP
Bx
CONTRACTOR ,g 1,a --^- } -I _ _•• _,/f -' .�.r ems.
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CONNECTION DATA
--- STATION �` N� AEPTH a'a
CITY ) .,. SEL NO.,% -•�L•?'- "' _._�. ...€ _ —.--- -----._.- __
MANHOLE REF;PENC� UPPER
[I STATE. .� =«-.— c6V+[ER s
REGISTRATION NO. '••? f - �� [] COUNTY -
NO, ; DESCRIPTION OF WORK FEE — "—` L
HOUSE SENDER CONNECTING TO TYPE OF CONNECTON LENGTH FROM
PUBLIC SEWER @ $.3.50! _Y _- .—CURB P L. _M.L. TO P--L----1
--
7 SEPTIC TANK,.SEEPAGE PIT OR {{
PITS AND/CR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD - P. C. NO.
EXIN.,CESSPOOL,DRYWELL,MANHOLE (1<t $2.00IM
1 _CO, A. NO. _ / OB NO.
it USE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM C $I.CD I TRUNK-PER-MIT-NO. — ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR �. .,1 STATE ENCROACHMENT
�J- WORK TO HOUSE SEWER __--- (c_$1.00I' { ,• s--,- PERMIT NO. _
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM �f4 °.�'I'm - _.. WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
M
OWNER'S PERMT _. --- - ------
----'--' '—'--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 21�g-� b/1cY
APPROiiALS 1 DATE 'INSPECTOR'S Si NATURF_
I HAVE :;T THIS DATE A COtdTRACT WITH THE, HEREIN NAMCON-
ED ____._.._____.___....___
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
-TO THE PURLtC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF •S9-- CONNECT ADDITIONAL
OWNER OR .F`^. BUILDING OR WORK
OWNERS AGENT—'.._._,.._ey.. •".-'I ----- -._,..__--_--._ _.
SEPTIC TANK,SEEP,PITS)
ADDRESo AND/OR DRAINFIELD
I H REBY ACKNOWLEDGE THAT I HAVE REAP THIS APPLICATION CESSPOOL) DRYWELL❑ y
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED. AND/ORF DISCONNECT
GPLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE VABANDON HOUSE SEWER t
CALIFORNIA R THAT I AM THE LEGAL OWNER OF THE ABOVE E ------ - --- ----- -- -- —_�
DESCRIBED RESIDENTIAL,. PROPERTY. BACKFILL SEPTIC TANKS' -
'� „r-
SIGNATURE SEEP. PIT(s) Ll CESSPOOLS Ll
f'. y, F F -..--- --.----------- ..-_�-. ,
OF PERMITTEE `, rem. �� -- --------
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION, `-.`e.. ROBERT A.WOOD, CHIEF PLSa, INSPECTOR
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C , M. 0. jl CASH -