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HomeMy Public PortalAbout6371 SULTANA AVE_Sewer__ (2) S E-So APPLICATION FOR PERMIT DIVISION OF BUILDING AND SFIMY SEWER—SEWAGE DISPOSAL Deportment of County Eaglneer i County of Los Angeles BUILDING FNM-J.FOX.COUNTY ENGINEER ADDRESS n{ CASSATT D.GRIFFIN,SU'P'T OF SumniNG LOCALITY �l _ FOR APPLICANT TO FILL IN NEAREST ! DESCPIPTTON] LOT NO OWNE& - .. e.._._--- ELOCK.,.._��TRACT ( A�DRES__? _�s. �';i ��-I!'•� '�, ---- - NO. OF BLDGS, - STZE OF LOT NOW ON LOT _��._.___•._� _ CITY USE OF — -----'-- _ BUiLDi NGS - DISTRICT HO. GROUP MAP BK PC CONTRACTOR ADDRESS 1' CONNECTION DATA � '-------`----ate--� - Ci'LY "Cy STATION - DEPTH - r,] STATE MANHOLE.REFERENCE p REGISTRATION NO. �.�"`' ✓ El COUNTYLOWEt'_� NO. n_SCpIPTION OF WORK FEE ---- ---- - -----._._��-_..- -------- ---- —I PI TYPECONNECTION- --- .__._ _ _ OF - P LENGTH LO OUSL WER CONa r7tN, TG Y. C13RB P L. � 1.. TO L. U s L I C J�C t. (c� - --_-�.�_ _-_. _...-.-• HOUSE SEVV R CONNEC NG TO Pnt4ATE DIS. nGS� SYSTEM i Gt ._-- i CONNECT AD)IT106.AL BLDG. OR P C NO. VfOR< TO HOU E SE5 ER ;.00 CO,[MP NO. JOh' iv 0. ALTER OR REPAIR En S :NG _ SEWER GP DISPOSAL SYSTEV- I 00! .----��-- TRUNK PERMIT NO, ROAD PER dT NO. ( MCON ECT AND ABANDON SEVVER STATE E CROACCH-MENT ----? ANGiOi WSPOSAL SYSTER:._...,_� 1 OJ�— PPt LRh,IT O. SEPTIC %LNK SEEPAGE PtT OR PITSINDUSTRIAL------------- - - ---------'---- -� A.ND OR f'RAINF 2 ALU G04 1111 - '1STt. ; A 1¢ROYL C} S 1 PC JL CK1`ti t_: -- , Svt ;/sf CJi t-ITIOPNS ONLY 2.00_ _-...—_ CHARGES CONNECTION CHAR =EE ow PERMIT AUTHORIZ BION TOTAL FEE � REltasuRs:;n EN FEL Ili A.s. T�.!S DATE CL TR �L7 WI-1-1 THE HEREIN cA !s�D f N- TRACTOR :O ONNC.r T THE ABOVE D,...SCRIBED EXISTING DAL. LING_ APPROVALS �� DATE !ANSPEC On SIGNATURETO Tyl',� PUBLIC 6EWEP NEW HOUSE SEAVER I SIGNED THIS C,WN€R O'r2 CONNECT A U Dei i 3NAL OWN ER.S BUILDING O;WOR;C. SEPTIC TANK, SC-P, PfT(S) AND/OR .IRAINrtt. D 1 HEREBY ACK OWLED;E THAT t H rAPPLICATION �4a: READ THIS APPLlc.AT tiOPd CLSSPO OL� DRY+r E,_L❑ AND STATE THAT T}!'- PROVE I CORRECT AND AGREE 10 C.ti M P4Y --- _._---Y-� _ W.I'H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ..-ALTER REPAIR EWER OR PLUMBING AND SLVsE-RS SEWAGE DISPOSAL SYSTEM _ I F!FI:t_UY CERTIPX THAT 1 AM, PRC'PFRLY REGISTERED AND/CR _ .�._,_._..._- LICEN>ED AS REQUIRED HY LOS ANGELES COUNTY AND STAT_ OF DISCONNECT PLUG AND �- NLIFORNIA OR THAT ! AIA THE LEGAL OWNER OF THE ABOVc ABANJGTv hG�d SERVER DESCRI=ED RESIDENT L P OPERTY, ., BACKFILL SEP PC FAtaKS r-] ; . . SEEP. PIT(S)LQ.- CESSPOOLS 0 SIGNATURE s OF PERNITTEE t WILLIAM J.FCOUNTY CN INFER 'V:ALWITION P-A.WOOD,CHIEF F4SG, INSPECTOR 'A � D