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HomeMy Public PortalAbout6421 SULTANA AVE_Sewer__ E-66$3-SS E-86APPLICATION F`OR.. PERMIT 16�. DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING > ` 1 5 J7A /1 J WM.J. FOX. COUNTY ENGINEER ADDRESS y� yvJ� j J CAHSATT D.GRIFFIN.'S UP'T OF BUILDING LOCALITY" FOR APPLICANT TO FILL IN NEAREST LEGAL -- DESCRIPTION LOT NO: OWNER BLOCK TRACT MAIL ADD ADDRESS N0. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO.USE OF BUILDINGS - DISTRICT NO. GROUP MAP- — - BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY 1EL. IVO. STATION 7" DEPTH REGISTRATION NO. L7_ STATE MANHOLE REFERENCE „� -1'v� UPPER _ ❑ COUNTY - __-- ✓r. �_,� ___� ^'__T�_ NO. ( DESCRIPTION OF WORK FEE -__-- .'—' TYPE OF CONIF.CT O - LENGTH FROM I HOUSE SEWER CONNECTING TO � Y, CURE P,L. .1 M.L. TO ?L. _ _ I ---- _.�. PUESLI(.SEWER f� § 3.50 f � - -_. ---�_ -- -- -�-- ' WOUSE SFWER CONIECT:NG TO PRIVATE DISPOSAL SYSTEM 1_00 - I -- - .- ----- - -.-- -� CON NECT ADD1tI0NAL BLDG. OR / -A P. C. NO. WOPK TO HOUSE SEWER 1.00 I. I't _.CO. imp. NO.- /`✓ �JCB NO. __—.----_-! - --- 9( ALIER OR REPAIR EXISTING SEWER C DISPOSAL SYSTEM 1.00 'IRUIy�£ PERMIT NO ROAD PERMIT 140. DISCONNECT AND ABANDON SEWER � STATE ENCROACHMENT ANL/QR DISPOSAL SYSTEM _ _ 1_.00 SEPTIC TANK SEEPAGE PIT OR _ — PERMIT f.0_---- ^—'-----�`A__-- PITS_?UND/OP DRAINFIELD ..00 1INDU$TRIAL — CESSPOOL DRYWELL WASTE A°PROVAL SPECIAL UO,14DITION_ONLY 2.00 � _ CHARGES "`" -----`--- -- CONNECTION CHARGE FEE ----- AiJTHORIZI Ie.>11 TOTAL FEE ^` �l" REIMBURSEMENT. E _F.EE I APPROVALS DATE I715P£CTOR'S SIGNATURE HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SENFR --._.— -"—.-_ -_ '—�- - --------- ---_I NEW HOUSE SEWER SIGNED THIS _.___ __.DAY OF—�_,_�,�_. ._____.�i9_ ._• OWNER OR CONNECT ADDITIONAL. -_ --_. ---- ---- .--- __ -BUILDING TIC K WORK OWNERS SEPTIC TANK SEEP, E EP, PIT(S)- A_DDRESS_-_.- _- _ _ _- SAND/OP DRAINNELD I HEREBY ACK.NOWLEOGE THAT I HAVE READ THIS APPLICATION CF_$SPOOLC] DRYIMELL© AND STATE I'HA.T THE ABOVE IS CORRECT AND AGREE TO COMPLY _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR PLUMBING AND SEWERS. SEWAGE.DISPOSAL SYSTENI } I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND;OR - '--- LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER _ DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS( - SEEP.PIT S) Fj CESSPOOLS Q SIGNATURE OF PERMITTEE WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLEG. INSPECTOR