HomeMy Public PortalAbout5034 SULTANA AVE_Sewer__ lTEULE CITY
Mae au' APPLICATION FOR PERMIT
Guoe a COUNTY OF LOS ANOEISB
SEWER—SEWAGE DISPOSAL
DEFARMENT OF COUNTY ENGINEER
BUMDING. AND SACFeETTY.DWMON ADU�LDINI.bultanaAve*
c Tr a e�Pm• s�n� av sm�o U=LITr 'NoMplA City
NEAREST
FO APPLI T CROSS BY
DESCRImONor e a taChe OWNER Olivia F. Price
BLOCK T � MAIL
)REss 5327 N. arnAllin
NO OF SIZE OF LOT NOW ON LOTS Tem le C1tVTEL NO
USE
BUILDINGS
LDIRG DISTRICT NO GBOUP MAP PeOC BT
CONTRACTOR • . M. E+ODruction _
e 731
ADDaRS01.5b Morth bleecker 6t, Cl CTION DATA
CIT*Baldadn Park TEL NO ED 8-3024 STATION DEPTH �
STAT[ MANHOLE REFERENCE
REGISTRATION NO COUNTY
ND DE RIPT F OR FEE
�U BLIC SEE EERBCONNECTING TO
EPTICTANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM ,
ITS AND/OR DRAINFIELD T CURB P L. Y L'TO P
L.
OVERFLOW SEEPAGfi PIT DRAINFIQLD
C P
YOU SEWER CONNECTING TO CfgP NO 0 JOB NO
1 1(9 HH7��L�1I�� EY
YCFONNECTRK TOt DDIJISEV/EBLDG OR TRUNK PERMIT NO ROAD PER
ATR PAIR OR ABA RDON HOUDQSTATE ENCROACHME
POSAL AT
00 PERMIT NO
INDUSTRIAL
WASTE APPRO
CHARGES
OVME 'Q I FFBMT 2100 CONNECTION CHARGE FEE
AUMO=AnON I TOTAL FEE 1 101 OO REIMBURSEMENT FEE
1 NATE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSP CTOR S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THISAY OF 9_ NEW HOUSE!EWER
OWNER OL CO NNECTADDITIONAL
OWNERS AGENT P �T BUILDING OR WORK
ADDRESS SEPTIC TANK LEEP PIT(S)
AMD OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS HEOUIHED BT LO! ANGELE! COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AY THE LEGAL 0 ER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT PROPERTY BACKFILLSE CTANE!
SIGNATURE SEEP PIT ! CE!lPoOLS
OF PERMITT
®' �(AIMATION ROBERT A WOOD '
CL L y CASE SUPERVISING MECHANICAL SNOINMEt
i ,AAPD4 5 5 3fa SEP20 1 0 D 10.00- q