HomeMy Public PortalAbout6438 SULTANA AVE_Sewer__ DFPART.MENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS A.NGET, S
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS -
FOR APPLICANT TO FILL IN LOCALITY _
'-
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. i PERMIT NO.
NEAREST
CROSS ST. ---'- _
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS _ 7t"' SK PG
CITY TEL.NO.
CONTRACTOR IT
/,� CO.IMP.NO.
ADDRESS t' .JOB.NO.
CITYTEL.NO.
Y- x TRUNK PERMIT NO.
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. — PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS. CHARGES
_ NOW ON L07 _
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
%'- PUBLIC_SEWER @ $ 3.50 _ RECEIPT NO. DATE JOY
r HOUSE SEWER CONNECTING TO I
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING NO. DATE BY
SEWER OR DISPOSAL SYSTEM IA0 I
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1._00 _ CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR <-
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER_
_ I TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
NAED
CONTRA TOIR TO CONNECT THDATETE ED ABOVE D SCRIBEDWITH THEI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS......_............DAY OF...._._...._.._........... NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERSAGENT...................................................................... I—
SEPTIC TANK,SEEP.PIT(S)
ADDRESS---....------------- ...................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL C] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. f BACKFILL SEPTIC TANKS❑
SIGNATUREtr t SEEP.PIT(S)ED CESSPOOLS
OF PERMITTEE.- S_.._--.. gg"
76 A642A 663 7/53
78A -66
E.683 I1-3S APPLICATION FOR PERMIT _ 1
3&a:
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
.JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS /`. 'Y :7' �, �a
GASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY14-2
-�
FOR APPLICANT TO FILL IN cuss ST.
LEGAL - -- -
D-ESCRIPTtON LOT N0. _ � L
BLOCK TRACT MAIL
AD➢RESS
N0.OF EiLDGS, CITY TEL. NO, r
S€ZE OF_LOT NOW ON LOT -
BUILDFNGS r2 _ DISTRICT NO. GROUP SK MAP PG
-coNaRAcToR
CONNECTION DATA
ADDRESS _ - ----- - --__ —_ --. ----
_ d STATION '1 yj✓, '
CITY DEPTH
L. NO, i .�. _ UPPER-
__. _ MANHOLE REFERENCE
�+ C STATE
REGY5TRATION N •�./ ❑ COUNTY
No. DESCRIPTION 0 WORK _FEE --- -- --- — -
-- TYPE OF CONNECTION LENGTH FROM
Py
HOUSE SEWER CONNECTING TO -/�' Y- CURB P.L" M.L.TO L.
PUB :y
_ _ _ I
I LIC SEWER - @ $3.50.' �---------- - - -
I SEPTIC TANK,SEEPAGE PIT OR -_,- - -- i -
PITS AND/OR DRAINFIELD CG $3.00 _---- ----- -------
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EYTN.,CLS POOL.DRYV ELL,MANHOLE f._ $2.00 CO, IMP. NO. �. — 1GB Aq.
HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL ScSTCM c` $1.00 j I TRUNK PERMIT NO. ROAD PERMIT NO.
! CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 6 $I-oo PERMIT NO.
ALTER,REPAIR.OR ABANDON HOUSE
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM CI: $1.00 WASTE APPROVAL
I' CHARGES
:CONNECTION CHARGE FEE
OVdimrs PERMIT - S -
AUTkiORIZATIQN TOTAL FEE REIMBURSEMENT=TEFF �+
APPROVALS I DATE �INSPECTOR`SSIGNATURE
I HAVE �.T THIS lll,1E.A CONTRACT WITH THE HEREIN AMFD CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX(STY. G DWELLING -TO THE PU3LIC EJ _ NEW HOUSE SEWER
SIGNED THIS ` OF 1 CONNECT ADDITIONAL - --- -----
044NER OR �. _ , _ad
f.4 1,.-, _ BUIL➢INGOR WURK_�_
OWNERS AGENT 1-� -
_ SEPTIC TANK,SEEP,PITS) ,I
°'� ' Lf �. _�....r,�t 'AND/OR DRAINPIELD
ADDRESS zv 'S—.:J _ _ --------- ———
--------------— - -- ------
I HF.RE,Y ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESS.POOLO DRYWELL❑ I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE. LAW'S REGULATING ALTER REPAIR SEWER OR - _I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERE3Y CERTIFY THAT I AM PROPERLY REGISTERED AND%OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ! I
ABANDON HOUSE SEWER
CALIFORNIA O TH T I M THE LEGAL OWNER_ OF THE ABOVE ---- ----- --- --+-- -- --------------
DESCRIBLD RES N A. a;.a' e5^ 8"5' * BACKFILL SEPTIC TANKS❑ -
' � 1'>~� IC I" 0'� ��• 'R`4`L• SEEP. PIT(5) Lj CESSPOOLS�P- -
SIGNATURE
OF PERMITTEE-
- f I
JOHN A. LAMBIE;COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PL-EIG. INSPECTOR
CK. N. 0. rr.,CAS.Y, -
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