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HomeMy Public PortalAbout6420 SULTANA AVE_Sewer__ 24650 INSERTS: APPLICATION FOR PERMIT, 78AN.TFD COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL Ul DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING y k ADDRESS �-- �. C-[. '`-�,s"'--z....--•,t.-W OHN A. LAMBIE, County Engineer 4VILLIAMT A. JENSEN, Supt of Buildinga LOCALITYNEAREST u-- NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL p' DESCRIPTION LOT NO. OWNER BLOCK TRACT MAIL * p .ADDRESS OF BLDGS. -"" - SIZE OF LOT OW ON LOT CITY TEL. NO - USE OF BUILDINGS DISTRICT NO. G OUP MAP PROCESSE.R'BY BK PG r e:. CONTRACTOR i1 0 w� _4') - , tom/ j ADDRESS L - ' ', ;_ CONNECTION DATA CITY 7. EL,NO. STATION DEPTH ❑ ATE MANHOLE REFERENCE UPPER REGISTRATION NO. ❑ COUNTY LOWER No. ] DESI,RIPTION OF WORK FEEr- HOUSE.SEWER CONNECTING TO PU8LIC SEWER C) $3.00 TYPE OF CONNECTION LENGTH FROM - SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L;TO P.L. PITS AND/OR DRAIINFIELD @ $$.00 — OVERFLOW SEEPAGE:NT. DRAINFIELD E'1(TN..CESSPOOL, DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO CO,EMP. N0. JOB N O PRIVATE DISPOSAL SYSTEM @ $1.00 CONNECT ADDITIONAL BLDG,OP. R ORY,TO HOUSE.SEWER $1.00 I'br,.. TRUNK PERMIT N0. ROAD PERMIT NO. O sN@ ALiFR, Rf AIR OR AFANDOY HOUSE STATE ENCROACHMENT SEWEk OR L`SFOSAL SYSTEM @ $1.00 PERMIT NO. ✓>� - INDUSTRIAL - U WASTE APPROVAL OV ER° ,/AtRMIT ~3 p Dp CONNECTION CHARGE FEE DT I AUTHORIZATION TOTAL FEE'-' REIMBURSEMENT FEE L 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY ONEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL I OWNERS AGENT BUILDING OR WORK _ ADDRESS SEPTIC TANK_,SEEP.PITS) -- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL. ❑ DRYWELL ©. WITH ALI.. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT UG AND CALIFORNIA WER OR THAT I AM THE ;IAL OWNER OF THE ABOVE DESCRIBED RE TIAL PR a RTY' r BACKFILL SEPTIC TANKS ❑ SIGNATURE J SEEP.PITS) Cl CESSPOOLS ❑ OF PERMITT Jp VALIDATIO4_ ROBERT A. WOOD ( Cls. N,D. CASH SUPERVISING MECHANICAL ENGINEER - 1. ll vo�p�GE N dos 5� 1N�' ✓ y6R6@gp312`'A O� OF �t pt C+p9�Rp�at GIN�ERIyG ti4055s5�' - i 9 Dep roau )c CoU p,s of r`' IGN�e$ -� .: No �� FG 't � . ! ipDR�...•- � aROUp 1` AL FAQ Gg k5tRt6.S�o D1-1EESGRIYTJO TRAGI N p\NOON;OT"/rJ�T C� DEYT NGE Bl-OG T\Op `' p, 'NUPpE RV LENG�Q pR� r". Sk2E o/ � fr j�� -' 5T A D M L. E OOF � _� GSOR ,.�-'.�j %�� �.�TAUETt � /� ti G,fNTRA Gi TEL NO'.✓" V • � _ NO,— ADDRSS a ...��, a sry' p_ � »./' ��,..✓ .�✓ lOaY -RkhkTNO• ROAD JAO- GkSTRATk ON pF DESp�p C�coN�aEG,kN �.� TR��E R fiGN�ENT '�4k£NRtDNE }{US'kFS SNRP ppRO AL ".GrHA tAL / lOO Api-4iGToe SFeU t5/G 00 /� W P �/ �•.. J" y'O Fx¢O IiE PD SIDSN ON GHAR`£F ES ��,5�IGri.TUR� gFv ER 0? nNAiS S'\S OR �f� ''�`.�'� `ONN�OT .y.�i p�SCO Rp15YOEPAGE ' AND O T�Nh SR g1Yfkv 00u �'1'vk�SkAN�4 ftDR Y�'0N Wil''' $ _.-,�-''`�' �- Jk•Lk�s g®��� ',-_.�'� '' ooN• uSE s ."--' N THE liEExjStlNG ..`�/g '�' —.ON GTGAORD TIOwCRx. o �ia rTED 4NDESGR16E0 �9 t g�p1NTANx, GONSRA�EOVE t t ,`,£Y11GR DRTki'iF ELLv f_�• �y SHl' Or^1NEGT THEhND70 k HpG DR 10g60' SES fB/DAY CE '� CESIeUOLE AlR 5EgYSTV �ALTE'RGE_°i jG ANLR 7�r�jdE R EAp THKEE T.�,U4ASlNG £ONNEGTOu'� KS to O c NT vt N£ R r1D AG S RE l p1SG DON H O TAN OOk,� 0 ODRES FJ� �K.NO�NL p�O�t N�SGOANDGStAT'l R�Y=TA¢ppPA oYE ..,4R YF p,i51T MESSY r'£ ERE6Y q}kPT ORplNA fROYE5LG0uR 06 'Itis AND 'TALL GOpNS£` RrtY,nS Vs AN--GAL O.NN OEY\)TY N Tk �i Y4 QRS RS NSIP 't FEQtR�Dt L`GL1FORµD RES Is SIGNATRMiTT _ Ly�INE.ER op Y Gou�T�� OGpLTY 0Y. TaT OtoLST T