HomeMy Public PortalAbout6411 SULTANA AVE_Sewer__ 76A6420
G&E-66.1 12-54 APPLICATION FOR PERMIT
DIVISION OF BUILDING AM SAFETY SEWER-SEWAGE DISPOSAL
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IN
F EER
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County
DepLu out of County Engineer
County of Los Angeles BUILDING
TY ADDRESS WM.J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUP'T OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN NEAREST
__.CROSS_ST.
LEGAL
-DESCRIPTION LOT NO. 'n
OWNER
-PAZ7, MAIL
ADDRESS
NO OF PLDGS.
1�
--NO_ ON LOT TEL.NO.
USE OF
DISTRICT NO, GROUP I MAP
BK PC
CONTRACTOR
ADDRESS CONNECTION DATA
STATION DEPTH
[I STATE PEFEqFNCE
REGISTRATION NO. COUNTY
TYPE CF CONNECTLENGTH FROM
N0. it DESvRIPTION OF WORK FEE Y. CURB P.L: MJ_TO P-L.
HOUSE SEWER CONNECTING
PUBLIC SEWER _ $ 3.50--
HOUSE SEWER ZONNE—cifNG TO
—I.-PRIVATE'DISPOSAL SYSTEM 1.00
CONNECTADDITIONALBLDG. OR Co. IMP. NO. JOB. NO.
1VI�iRK 70 HOU 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM1.00 I `TRUNK PERMIT NO. ROAD PERMIT NO-
DISCONNECT AND ABANDON SEWER ii
ANDDISPOSAL SYSTEM 1.00 �TATE ENCROACHMENT
PERM[T NO.
SEPTIC 1ANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00
CHARGES
CONNECTION CHARGE FEE
OVINER,S PERMIT 11 00 --
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS LATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER I
el es� A.— NEW HOUSE SEWER
SIGNED THIS_ .+
OF- 1V
OWNER OR BUILDNG OR WORK CONNECT ADDITIONAL
i
OWNERS Ar INT A_
rR DRAINFIELDEITIC TANK,SEEP, PIT($)
ALDRESS_A�EO_f fj- t'dtl
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL C3
AND 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. SEWAGE Dig OSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OH
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OW14ER OF THE ABOVE __ABANDON HOUSE SEWER
DESCRIBED RES I DENTIA1,PROPERTY. BACKFILL SEPTIC TANKS 0
SEEP.PIT(S) CESSPOOLS
SIGNATURE
Z?
OF PERMi TE
WILLIAM J. FOX.COU TY ENGINEER VALIDATION
By By,
DEPUTY DEPUTY
BY By
Cry DEPUTY DEPUTY