HomeMy Public PortalAbout6370 SULTANA AVE_Sewer__ ear y ..
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�.-cAPPLICATION . FOR PERM46
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,DIVISION OF BUMDINfG AM SAFETY SEWER—SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
SS
V9 M.J. FOX, COUNTY ENGINEER
CASSATT I?. GRIFFIN, SUWT OF RUILDfNr, LOCALITY
FOR APPLICANT TO FILL INNEAREST
CROSS ST.
LEGAL m
D.ESCR PTION LOT NO.
OWNER - -
BLOCK ""TRACT �MAIL
ADDRESS ..
NO. OF BLDGS,
SIZE OF LCTe d# a NOVJ GN LGT TEL. NO.
USE OF
BUILDINGS
_.,--- '' . ....- _ _ ._-_-_._.. - DISTRICT NO. GROUP � MAP
I3% PG
C N'RACT.CT.7
ADDRESS — CONNECTION DATA
CITY : TEL. NO: STATION .d DEPTH
J S'IA'CE y,.E"
MANHOLE REFERENCE �—
REGISTR:ATION NO. 1:1 COUNTY _(�-'( . fir'"r» UPPER _. LOWEP� -
_- -. TYPE:OF rONNECTI :.... LENGTH T'Rt M4,S,��.j7
:NO. DESCRIPTION OF WORK FEE Y; CURB I P.L.? Ir.L 7G_P.L��
HOUSE SEWER CONNECTING TO
PUBLIC.SEINER
HOUSESEWER CONNECTING"TO -�
PRIVATE DISPOSAL SYSTEM -
�� CONNECT ADDITIONAL BLDG, OR I CO. IMP. NO iy.` �� � JOB. NO.
WORK TO HOUSE SEWER - -- -
ALTER OR REPAIR EXISTING
�
SEWER OR DISPOSAL SYSTEM 3.04 i
TRUNK PERMIT NO. ROAD PERMIT NO.,
DIS.CONNE I AND ABANDON SEWER 1d STATE ENCROACHMENT v —�_..--!`--
__ AND/Oa DISPOSAL SYSTEM. 1.00
PERMIT N0.
aEP17 TANK -£WAGE PIT OR
AND/OR DRA NFIEI D 2 -- INDUSTRIAL
O I
'WASE APPROVAL
� CwS5PO0L DRY NlE�L y9-•^ - -
{ SPECIAL CONDITIONS ONLY 2 00 CHAqGCS -
-• - --� -- CONNECTION CHARGE FEE
PERMIT
AU` HORMATION TOTAL F — — j C 3 REIMBURSEMENT FEE
s
I
HAVE THIS DAME CONTRACTED WITH THE HEREIN 'NAM D CCN- APPROVALS
TRACTOR.TO CONNECT THE .ABOVE D,:SCR BFG EXISTING DWELOI NG SEWER DAVE INSPECTORS$4GNATURE
TO THE PUBLIC SEWFR
SIGNED THIS PAY O NEW HOUSE�cVALR m-
OwN.ER OR - CONNECT ADDITIONAL
OWNZRS AGENT " BUILDING OR WORK
.�3- .. SEPTIC TANK, SEEP,PITS) -
ADDRESS__.`,`;` ='..._,_ _.`. --. .AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .CESSPOOL O DRYWELL(]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -----F--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING: ALTER, REPAIR.,SnVER OR
PLUMBING-..AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT i AM PROPERLY REGISTERED AND/ORDISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE GFF
CALIFORNIA OR THAT I AAI THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER _
DESCRIBED RESIDENTIAL PROPIERTY. BACKFILL SEPTIC TANKS 0
SEEP. PLT(S) []CESSPOOLS Q .
SIGNATUR - _ ,_
r
OF P£R:MITTEE - -
`YM1fIL LIAM J. FOX.COUNTY ENGiNmR VALIDATION
BY BY
DEPUTY DEPUTY
J n;
W'
EY BY
DEPUTY .< DEPUTY -