HomeMy Public PortalAbout6371 SULTANA AVE_Sewer__ 6A 6420 -CE808 -10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS /y
LOCALITY �L. �,.� ,,/t z.
NEAREST
FOR APPLICANT TO FILL IN cRoss ST. ►/-=-LF—GAL-----
DESCRIPTION
EGAL. ___DESCRIPTION LOT NO OWNER �" l
MAIL
BLOCK TRACT ...,��..: r :LL�_..iY`-z _._. ADDRESS : ` )YS,/�. ,J, 4�L �JrP lY rlYa+3�� 'd
-_--
NO. OF BLDGS. c,=,�7✓h,�, AEL, NO. 22 7
O
SIZE OF LOT NOW ON LT CITY �.
USE OF
BUILDINGS DISTRICT NO. GROUP I SK MAP PROCESSED BY
cg
CONTRACTOR - —_— l L b f J.
ADDRESS CONNEC77ON DATA
CITY TEL. NO. STATION DEPTH
STATE LIC MANHOLE REFERENCE /UPPER
LICENSE NO, CLASS LOWER
NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LEN H FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M:'C.70 P.L.
PUBLIC SEWER @ $7.00
C.
SEPTIC TANK.SEJ
EPAGE PIT OR - OB NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO.
OB NO,
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVERERS EMENi
. RECORD. INSTR.NO. DATE (�
WORK TO HOUSE SEWER @ $3,00 �,�G?
OVERFLOW SEEPAGE PITDRAINFIELD LK
EXTN,.CESSPOOL.DRYWELL. a 55.00 HWY.OR ST.W ENING o
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT W
MANHOLE --- $7.00 PERMIT NO. CL
— - INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 3 00 CHARGES Z
// CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT -- —
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP.PITS)
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING n
PLUMBING AND SEWERS. CESSPOOL ElDRYWELL ED
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAI R.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE. LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV. `D SCRIBED RESIDENITI�L PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE BACKFILL SEPTIC TANKS ❑
��. -h=-.Y L-' '�. —r SEEP.PITS) El. CESSPOOL ❑
VALID TION CASH
705 aUG 81L) 9 6.OUA►Jb
E-663 11-55
APPLICATION FOR PERMIT _1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Lbs Angeles BUILDING
ADDRESS .
JOHN A. L,4NIEVE, COUNTY ENGINEER
CASSATT D, GRIFFIN, SUPT OF Yi UILDiNG LOCALITY '
NEAREST
FOB. APPLICANT TO FILL IN CROSS ST r
6ESI RIPTION LOT NO i. c _r3- OWNER-
BLOCK �TRAC" "� �." r r s MAIL
t_
ADDRESS
NO.OF BI DGS a l: Nri
SIZE OF Lf >''` s'' NOW ON LOT - CITY TEL. NO.
USE OF DISTRICT NO. GROUP 1 MAP
BUILDINGS __y__ BK PG
CONTRACTOR
ADDRESS • < i r -; __ CONNECTION DATA
CITY
TEL. Nt7 STATION _ ,;c., DEPT__H_ —.- -
-a----1 MANHOLE REF "NCE �;. + '/ �,�
STATE _ .--------- -- TOWER_
REGISTRATFQN NO. c - --. ---
-- _ ❑ COUNTY
No. j DESCRIPTION OF WORK FEE --'— ---- -- -: --
--- - TYPE OF CONNECTION LENGTH FROM -
HOUSE SEWER CONNECTING TOC' Y. CURB .L
PUBLiCSEWER a $,3.501 - - _-_--
SEPTIC TANK SEEPAGE PIT OR
PLTS AXD R DPAINFIELD _�'� $3.00 -,-
i OVERFLOW SEEPAC} Pit. DRA(NFIELD �I--- P.C NO.
EXTM.,CESaP00L,4RY4'JELL,h!ANY,OE L. C`i sP„QO LO. IMP. NOe " 3 JOB Nv.
4 HOUSE SEWER CONNECTING TO 1 1
PRIVATE DISPOSALS STEM c; $1,00 1 TRUNK PERMIT N.0 ROAD PERM!. O.
CONNECT ADDITIONAL ELDG OR --
j WORK TO_HOUSE i SLATE.ENCROAC'i+ NT
_ _ -$1_00 FERMI 0.
(
ALTER,REPAIR Oil ABANDON HOUSE
r $1. IN:DUSTRI.'I- - -
SEWER OR DISPOSAL--- SYSTEM — 00
--�u - I __^�_._ WASTE APPROVA`L""'�4.,..
CONNECTI CHARGE FEE
OWNER'S PERMIT
_.__--- -------- -`ids BEIM RSEMENT.FEE
AUTHORIZATION FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS j 4Y7E SIN Pk CTCR'S'SIGNATUP,E
TRACTOR TO CONNECT THE ABOVE DESCAI,BED EXISTING DWELLING
TO T!E PUBLIC SEWER. ;i NEW HOUSE SEWER ;:
SIGNED THIS. DA y 0 1S_ 'y coNNLct ADDITiONALOWNERORORS,. - LUILD NG OR WORK -
Ow _...: nCEN7
� SEPTIC TANK,SFFF FT(S)
R t7DR.£SS PND/OR DRAIN(IC O j
— - -- --...— ------ _-- — ._ — --
I HEREBY ACKNOWLEDGE T4AT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLO 1
AND STATE THAT THE ABOVE i5 CORRECT AND AGREE TO COMPLY _ ---- --.--. --.-_--...—j..._ -.-__.._ .-_-_ -----
WITH ALL COUNTY ORDINANCES AND STATE LAWNS REGULATING ALTER,REPAIR„SEWER OR 1 i
PLUMBING AND SEVIERS• SEWAGE DI$POSAL SYSTEM
HEREBY CERTIFY THAT 7 AM ANGELES
Lf REGISTERED AND/OR DISCONNECT PLUG AND I
CALIFORNIAAS REGIiiP.ED 8Y LOS ANGELES 'COUNTY AND STATE, OF ABANDON HOUSE SEWER
CAL!FOR (3R THii7 i AM Tk+k LEGAL. OWNLR OF THE A*?OVE ----" - ------ -- --I.-_.-__ �_..-_
DESCRIBED RESIDE3LT!AL PROPERTY, BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S) +,.._! CESSPOOLS❑_OF PERM IT-TEE° , iY-
i
IOHN A.L.AMBIE. COUNTY ENGINEER VA:LIDATIO ROBERT A, WOOD,Cf-itEF PLUG. INSPECTOR
- GK: N O, CASH
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