HomeMy Public PortalAbout6427 SULTANA AVE_Sewer__ E.C63 3-65 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEINER-SEWAGE DISPOSAL y
Deportment of County Engineer
County of Los Angeles BG
—
WM.J. FOX. COUNTY ENGINEER —UILDIN
CASSATT D.GRIFFIN, Sup'T of BUILDING LOCALITY
FOR APPLICANT TO "
!w3ti t-/ 4 ars FILL IN NEARESTT.
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LEGAL —
DESCRIPTION -LOT NO. N j r. ,a• r L'+� OWNER i - - .„j— %✓', '. _�
_— —MAIL -
BLOCK TRACT
NO. OF BLDGS. R �—
S1ZE OF_LOT _NOLV ON LOT _ CITY - TEL. NO.
USE OF ''� N r� • _
BUILDINGS DISTRICT NO. GROUP (- MAP
BK PG
CONTRACTORzo.
ADDRESS r�= s - CONNECTION DATA ^
CIT TEL, NO. y” STATION
- i� - --------a'- �'. , DEPTH ---
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E&--SYATE ..MANHOLE REFERENCE.-
REGISTRAT'' N O. COUNTY
NO. — DESCRIPTION OF WORK �d FEE
--!{ TYPE OF CONNECTICN LENGTH FROM
HOUSE SEWER CONNECTING TO k
PUBLIC SEVER Y. CURB Y L i V.L. TO P.L.
_ C S 5.50 - -- —
fsOLSE.S ti ER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1_00 _ - -- ----
C NNECT ADDITIONAL BLDG. OR P C N0.
b1
C R K TO NO}S_E S-EWER_ 1.00 it-- CO._IMt•. NO,
1.
^i '6' C REPAIR EXISTING--
t SEWER OR D"POS L SYSTEi.4 t.OA TRUNK PERMIT NO. ROAD PERMIT NO.
—I( !_ NEAND ABANDONSEWER
ASDCOOhR DISPOSAL SYSTEM STATE ENCROACHMENT
ERRIT NO
SrPT1C TANK, SEEPAGE PIT O4 -- -"— _ - -- "------' — ---
`i P1 --
-S AIND/CR DRAINFIELD 2..0:0INCUS TIAL
CESSPOOL>DRYYJELL ---�-~_ HASTE APPROVAL
SPF_CIAL CONDITIONS ONLY 2.00 _ I CHARGES
----_' J� --CONNECTION CHARGE FEE
OWNER'S PER141T $ 11 co
AUTHO'.3—TZATION I TOTAL FEE REIMBURSEMENT FES
I HAVE THIS DATE CONTRACTED WITH THE i- FIN .ANDD CON-
TRACTOR
ON- =p} �e a
TRAC OR TO CONNECT THE ABOVE DESCRIBED EXISTING DNELLING APPROVALS DATE �INSPECTOR'S SIGNATURE
TO TETE PUBLIC SEV-R - - _.- - e —� -----.-- --
NEW HOUSE SEWER
SIGNED TY;S DAY OF- fl —"� ---
OWNER -.,. OR '. �,• CONNECT xDDiT10°dAL —
OVJNGRS,. :.� � G_O_R WOP_K__- !!
SEPTIC TANK,SEEP, PiT(S) {s
ADDRESS—-. I '�®+ y"� _ AND/OR DA'AiNFIE'LD !
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL C} DRYWELL 0! ��
AND S'fATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLt t Y,1NG AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANU/OR --"-----"�--`--" —
LICENSED A5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AA THE LEGAL OWNER OF THE ABOVE: ABA*IDOti HOUSE ScVJEft t
DESCRIBED R SIDENTIAL PROPE Y.
_ P BACKFILL SEPTIC TANKS E
+MVV SEEP. PITS) i�]�CESSPGCLS ]_ (c _
OF PERMITTE f J
WILLIAM J.FOX, COUNTY ENGINEER 'VALIDATION R.A.WOOD,CHIEF FLBG. INSPECTOR