HomeMy Public PortalAbout6401 SULTANA AVE_Sewer__ Ed E� 92.54 APPLICATION Fr pPERMIT EyMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angeles BUILDING r -
WM.J. FOX, COUNTY ENGINEER ADDRESS . i. ,
-CASSATT D.GRIFFIN.SUPT OF BUILDJNG LOCALITY
FOR APPLICANT TO FILL INNEAREST
- CROs5 ST, r
LEGAL
DESCRIPTION i LOT NOda�isc� a , ".,. cw -� i OWNER
BLOCK TRACT ✓
r�f✓S'LL.� N;:.g: �,' '. ' MAIL
t o�'
,jt A
SI7C_OF 1.CT ;.�r,s' NOW ON LOT - CITY TEL.
USE OF ,r'
BUILDINGS ,�';,.,..�,,�r t ,;.'`f ,;,, DISTRICT NO. GROUP I MAP
BK P T
f
CONTRACTOR J
ADDRESS CONNECTION DATA
CITY TEL, NO : STATION . + DEPTH :
.._�...-�...�..�-..STATE— r ,� - MANHO .E REFERENCE: .�.-__.. .-._._..
REGISTRATION NO. t_J COUNTY t I°'� � _ .R - _�LOW
TYPE OF CONNECT iv LENGTH FROM
NO. DESCRIPTION OF WORK F'£E .- CURB L. M.L.TO P.L.N' >
HOUSE SEWER CONNECTING TO -
_ I PUBLIC SEWER _ _ _ _(
f HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM. _ 1.00 •---
CgNNECT ADDITIONAL BLDG. OR ! j
WORK CO. I
TO HOUSE SEINER_ -- 1.00 i IMP. NO JGR_Id0_ - _-
-ALTER OR REPAIR EX.S'TING --
SE E.R CR DISPOSAL SYSTEM _ 1.00 —I TRUNK PERMIT NO. ROAD-PERMIT NO.
DISCONNECT AND ABANDON SEWER — � - _-- —�—_- - ----_
1 I STATE ENCROACHMENT
-i
AND/OR DISPOSAL SYSTEM_ _ 1-00 +� -,S£PTiG'TANK, SEEPAGE PIT OR _PERMIT N0.
PiTS AND/OR D_RAINFIELD 2.00 � �- INDUSTRIAL
�� CESSPOOL-DRYW ELL V)ASIF APPROVAL
5?ECTAL CONDITIONS ONLY 2.00 I CHARGES
CONNECTION CHARGE FEE
OWNER'SPERMIT 100
_ EE TOTAL FEE I I:EIMBUPSENICNT F
AUTHORIZATION I � � �3" -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ASOVE DESCRIBED EXISTING DWELLING _
TO THE PLBLCC� SEW R _ - -
SIGNED THIS'-/ DAY OF "� t-' j9 +-� NEW HOUSE SEWER �
CONNECT ADDITIONAL
� --- -v.-- -- - ---
OWNER OR e" '.7�� s
OWNERS AGENT—1 i ',qy ,;..:: ^" '��-•, BUILDING OR WORK
``--�'. ` ��o -SEPTIC TANK, SEEP, PIT($)
ADDRESS.-, if -' 'V _ `¢- "`' r'' _ AND:/OR DRAINrIELD
I HEREBY ACKNCWS.EDGE THAT I HAVE READ THIS APPLICATION CESSPOOL G DRYWELL[�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AlA PROPERLY REGISTERED AND/OF, DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER___
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ------ --
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
- _SEEP.PIT(S7 -
1 SIGNATURE
OF PERMITTEE
WILLIAM J. FOX,COUNTY ENGINEER VAIMATION
SY 8Y' a
DEPUTY DEPUTY
BY BY
VDEPUTY DkobTy
DEPAIVrM-ENT OF COUNW ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNT17 OF LOS ANGELES BUILDINGr -
WILLIAM J. FOX, COUNTY ENGINEER -ADDRESS J (_0� I q x
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
_ADDRESS 66QJ Sultana Sti• CROSS ST.
LOCALITYTearrol8 Git3Ts C8 L3 f. DISTRICT NO. SERIAL NO. PERM�ITT NO.
•�
NEAREST ( _-` /✓
CROSS ST. — '—
REC IV Ready for inspection DATE 1 SUE
OWNER 2ARPESE & DEDETTMICTMAIL ,tom
ADDRESS USE ZON CCCUPAUCY MA
_ 10310 Lower Azusa Rd. (
CITY El Monte, TEL.NO. BK PG- --- ---
CONTRACTOR BURKE-HOVIARD CO.IRI P.N0. `
ADDRESS 2436 No. R•oaemead Blvd. JOB NO.
CITY El Monte, Cali f.TEL.NO. TRUNK PERMIT NO.
p ❑ STATE
REGISTRATION NO. 3792 B O COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. j y PERMIT NO.
BLOCK TRACT ,, INDUSTRIALWASTEiAPPROVAL
SIZE OF LOT p/� NO.OF BLDGS.
( `/ NOW ON LOT CH ,RGES
USOF
BUE DINGS Dwelling CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER @ $ 3.50_ RECEIPT NO. ( DATE I BY
HOUSE CONNECTING
�- PR VATEEWER DISP SAL SYSTEM TO 1.00 l QQ
CONNECT ADDITIONAL BLDG.OR EXCOPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO-,,I DATE I BY
_SEWER OR DISPOSAL SYSTEM 1.00 II
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ---
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
l
SPECIAL CONDITIONS ONLY 2.00 2 00 MANHOLE REFERENCE
-- UPPEJi LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB S.L. M.L.TO P.L.
AUTHORIZATION � TOTAL FEE L, 00
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
i
SIGNED THIS......._...........DAY OF..............-_.............._......I9NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT....-.--.----
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-....................-----.................................----.............................. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL —'
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 AND
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES` COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT - AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED,RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
- SEEP.PIT(S)D CESSPOOLS
SIGNATURE
OF PERMITTEE-__""'r----.-- -• -.......-.. ._...•-•--. -
76A642A 663 7/53