HomeMy Public PortalAbout6439 SULTANA AVE_Sewer__ TBABARD - �jy ` �/ `
•&EBOX IA BA APPLICATION F R PERMIT 1
DIVISION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL
DBpmtmMot a CRmnty EagIn..E
Cotmty a LQM AagalMs BUILDING
WM J FOX COUNTY ENGINEER ADDRESS 64
• CAEGATT O GRIFFW,Mur T or GUILDIND LOCALITY (y /� L
FOR APPLICANT TO IN k NEAREST
CROBB$T A4 De r eAv
DESCRIPTION LOT NO Pel. {'1 LE OWNER 'P
BLOCK TRACT MAIL
j O OP ADDRESS
BLDG9
SIZE OF LOT V NOW ON LOT CITY TEL NO
USE OF
BUILD IN09 Q DISTRICT NOG ROIIL YAP
CONTRACTOR I L^ N alC ��" BK PO
ADDRESS 4 O N C COMMON DATA
CITY Q TEL NO A STATION DEPTH
REGISTRATION NO go 13COUNTY / 'UPP we REFERENCE 40cma►
TYPE OFCO NNECTI LENGTH FROM x'RCL
ND DESCRIPTION OF WORK FEE Y CURB P L ' L
To PRL V
IHOUSE SEWER CONNECTING TO
•PUBLIC SEWER ® S SSD "
1 HOUSE SEWER CONNECTING TO
• I PRIVATE DISPOSAL SYSTEM I GO
'CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 1 00 CO IMP NO SQ JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
�
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR ,
PITS AND/OR GRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
ovn; 'S p�Mn S 1 00
AUTHORIZATION TOTAL Ply REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAL$ DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER
SIGNED THISGAY OF 19— MEW HOUSE SEWER -� A a
OWNER ORp �AO CONNECT ADDITIONAL
OWNERS AGENT r 0-Q/�.. „__ _—J _ BUILDING OR WORK
SEPTIC TANK,SEEP, PIT($)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRWELLO
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 DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OA DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL ROPERTY
SEEP ILL BE IC TANKS f-1
-
SEEP
PIT B cfeel'M-LS
SIGNATURE
OF PERYITT /
106 eLfi6 BROKEN
WILLIAM J FOX, COY ENGINQ- VALIDATION O
s �
BY - BY 4.5
• DEPUTY ,-�/�9 DEPUTY
�-
BY By jC0619, 3 � •
m DEPUTY - Pu
COUNTY OF IAS ABGHLRS TEMPLE CITY Y 0508 SEWER PERMIT
DEPARTMENT 09 PUBLIC WORKS 9701 LAS TURAS SS 0508 0610030001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91760 '
PHONE (626) 205-0486 EKY
LEG" ID BEMER SEPTIC SEWER BUILDING ADDRESS
ON PILE EXIST OCC GRP 6439 SULTANA AV
BLDGS NOW ON LOT SQAB CA 917752033
ASSESSOR INFORMATION NUMBER CONNECTION TYPE NEAREST CROSS STREET LOBGDEH
5383-031-002 ORIGINATION THOMAS PAGE 596 GRID B1 LOCALITY TEMPLE CITY C
LENGTH ML TO PL STATION DEPTH
TBILKST MANHOLE REFERENCE UPPER/LOWER ISSUED ON PROCESSED BY EXPIRES ON
10/03/06 JK 04/01/00
COUNTY IMPROVEMENT NUMBER
OWNER TEL HO PLAN CHECK NUMBER FINAL DATEPIN11L BY CODE
MSJIA RAMON G,LUISE M (616) 287-7250- JOB NUMBER 101L b 6
6439 SULTANA AV IRURK PERMIT NUMBER
SGAB 917752033 ROAD PERMIT NUMBER DESCRIPTION OF WORK
APFADAVIT NO RAPAIP SHIRR LINE
WAIVER NO r
APPLICANT TEL NO EASEMENT NO
RAPID PLUMBING (714) 695-1800-
5751 UPLANDER MAY RECORD INSTRUMENT NUR RECORD DATE SPRCIAL CONDITIONS
CULVER CITY CA 90230 HIGHWAY/STREET WIDENING
STATE ENCROACHMENT PERMIT NUMBER
CONTRACTOR TEL NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
RAPID PLUMBING (714) 695-1800-
5761 UPLARDER WAY LIC NO FEB DESCRIPTION QUANTITY UDM AMOUNT NEW HOUSE SEWER
CULVEN CITY CA 90230 521992 C36
01 PERMIT ISSUANCE FEE 27 75 CONNEr.ZT ADDITIONAL
•3 WORK TO HOUSE SEWER 1 00 EAC 30 45 BUILDING OR WORK
ARCHITECT OR ENGINEER TEL NO TOTAL PEES 58 20
SEPTIC TANK, SEEPAGE PIT
LIC 90 AND/OR DRAIM FIELD
DRYYELL
SENSE MAP BOOK PAGE _ ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM _
DISCOVNECT PLUG AND
1 ABANDJN HOUSE BEER
BACKFILL SEPTIC TANKS _
SEEP PIT CESSPOOL
GRAYMATER SYSTEM
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REPORT ID DPR166 ROU1'H TO 880508
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