HomeMy Public PortalAbout5027-5029 SULTANA AVE_Sewer__ T°"•'II°
caw°a Be APPLICATION FOR PERMIT
COUN" Or LOS ANGELES SEWER—SEWAGE DISPOSAL
-,=PARTmENr or comm ENGnmm
BUILDING AND sArerr DrmoN 1013NADCLDRF9 ! 2 v M
NCA. LANMER Ca .r Carr MmulnoE r
CABBATY D GRIPPDT.BMp'1 of B°Rd!°G LOCALITY
OH APPLICANT TO Ncaoia sr 6 v .q
LEGAL it L
DESCRIPTION LOT NO7T4 OWNER (/
BLOCK TNACT MAIL
ADDRESS
NO OF SUDGS A AA
SIZE OF LOT NOW ON LOT
CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP YAP PROCEJSED BY
CONTRACTOR }.� BK PG
ADDRESS AVE. -JI• commcrlom DA?A
CITY PIUMMULLUIMI. NO ?A 1-5048 STATION A DEPTH
REGISTRATION NO STATE CouNA N"T' MANHOLE RfiFERENCK
No I DESCRIPTION OF WORK FEE LOWER
HOUSE R
SEWSI
COCONNECNG TOPUB !
DO
SEPTIC NK 4EEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM
PITS AND�OR DNAI HFIELD S DO T CURB P Y L TO P L
OVERFLOW SEEPAGE PIT DRAINFlELD
EKTN CESSPOOL DRYR'E�I.L MANHOLE S 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER 111 00
ALTER REP,1IR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR D S SAL SYSTEM 1 00 PERMIT NO
'NDUSTRIAL
WASTE APPROVAL,
CHARG
O�sPEHbnT
CORMECTION CHARGE FEE
AUTHOHMATION BEIMOURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR B SIGNATURE
TRACTOR TO CORRECT THE ABOVE DESCRIBED BUSTING DWELLING
TO THE PUBLIC SEWER S
SIGNED iH F T g HEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWflERa AGfi BUILDING OR WORK
SEPTIC TANK SEEP,PITReI
ADDRIYII AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCE! AND STATE LAWS REGULATING ALTER REPAIR !EWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I, HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY Loa ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T T AY T GAL OWNER OF THE ABOVE _
DESCRIBED REST PRO SEEP PIT
T SE C TANKSCESSPO0 -iL-& I-J' T
SIGNATURE
OF PERP
®. VALIDATION ROBERTA WOOD
111CK G eue MUPBRVISINO MMCHANICA.BNOINEER
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