HomeMy Public PortalAbout6402 SULTANA AVE_Sewer__ '6A ,66
M•E63 3.36 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER---SEWAGE DIS o9y�
Department of County Engineer
County of Los Angeles BVTLDING
ADDRESS'+I` _ '
WM.J. FOX, COUNTY ENGINEER ZZ
—
GASSATT D.GRIFFIN,SUPT OF BUILDING LOC4LITY
FOR APPIJCANT,TO FILL IN NEAREST
CROSS'Te
0 r a' -'`-' rF
LEGAL - --
DESCRt OWrJr9,
BLOCK ��" .fes)` ,f # MAAILIL
--
- — ADDRESS
,�si, �"mak 0 N0. OF BLDCS. •'/
SIZE CF-LOQ' %`x''i+.�- ". NOW ON LOT ,/' CITY
_ 7h-+50.
USE OF
BU1LFi NGS 'A. -�-..= r- _ DISTRICT N0. GROUP j NAP
SK PG
AD RFS t F�` ,.- � CONNECTION DATA
k`T�`Ya� STATION—�A'{ T
rYTj'' DEPTH b"r
Ij STATE MANHOLE REFERENA.� ,C- , ., UPPER_
REGISTRATION N0. !' /"� � �°'.J COUNTY `•- ---_ �" -
NO. I DESCRIPTION OF WORK FEE -- _
-- _ TYPE OF CONNECTIO LENGTH FROM
HOU5 SEtk£R COMNEETING TO $ 50 �� Y. _CURB _._ L a M.L. TO P.L.
J j PUBLICSEWER _ 3,
�IHOUSE SEWER CONNECTING TO — --
PRIVATE DISPOSAL SYSTEM 1.00
COINNECT ADDITIONAL SLOG. OR I R. C. N0.
TO F:OUSE StMt_R NO.
--�
ALTER OR REPAIR EXISTING I -- _- -- - - — �__--.—
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
t
-. DISCONECT AND ABANDON SEWER STATE ENCROACHMENT
AN. /O^ DISPOSAL SYSTEM _ 1.00
-
SEPTIC TANS' SEEPAGE PIT OR PERMIT NO.
PITS AND/OP DRA1Nr ELD 2.00 INDUSTRIAL
WASTE APPROVAL
CESSPOOL DRYWELL <
4 SPECIAL CONDITIONS ONLY2.00.4,..--_T -
--� - CHAR •S
�+� '� PERMIT
, �� �� - -CONNECTION CHARGE FEE_ - --�-
a7L6dSI"�3®[1I�.aATIOi7 TOTAL Fri; --,1/" i ✓s-- RETMBURS15MENT FEE.
I HAVE THIS DATE CONTIZACTED WITH THE HERE1 NAMED CON-
x4 ry 7�x
TRACTOR TO CONNECT T ABOVE DESCBLSED ESTUNG DUELLING.- APPROR�d91,n�Jy DATE INSPECTOR`SSIGNATURE
TO THE PUBLICSPS .� 6` '---'----"�."°. --- - --- — — --- -- -- ---
NEW HOUSE SEWER
SIGNED THIS r4 �DAY OF'� "' � �J'�e�
OWNUR 0 '`sr.'. o ��. CQ?v?VE T ADDITIONAL
OWNERS A'GEN - �� -'"``r"Y`'• _BUILDING OR WORK_ 111
SEPTIC TANK,SEEP, PIT(S) i
AN_D/OR DRAT_NFIE_LD _
AN1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[I DRYWrLL0
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. ALTER.
DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE CF DISCONNECT PLUG AND
CALIFORNIA,OR THAT I AM THE LgGAV OWNER OF THE ABOVE ABANDON HOUSE SE4YEP.
DL•5GRISED'-1atics DENT46?W;PROPERTY ,r.,.�
� BACKFILL SEPTIC TANKS fes'
^` SEEP.PITS) El CESSPOOLS fes... _
SIGNATUHFVf f' rr� l ✓(r F`. i" t.C"nP( 'r.;'
"dF P�MkT'I'EE -
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FL,BG. INSPECTOR
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