HomeMy Public PortalAbout5044 SULTANA AVE_Sewer__ :EBOB 5 65 APPLICATION F07PERMIT
T ea BAzO I
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ILJI
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING 0
JOHN A LANIRIF County FDg(Deer ADDRESS
COLE\IAN IN JF VAI%S Sop of RoddIDX S
LOCALITY
NGR66T
FOR APPLICANT TO FELL IN cflo*S Br
L 0AL
DESCRIPTION LOT NO OWNER
MAIL
CLOCK TRACT ADDRESS
NO OF BLDG$
SIZE OF LOT NOW ON LOT CITY TEL NO
UCC OF A DISTRICT NO OROU MAP PROCEIICED CY
CUILOINOC
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CONT1AiN51H S PLUMBING,INO. ��Q —
ADDR2407 N. Lee Ave. CONNECTION DATA
El Monte TEL ND444-0628 STATION DEPTH
LICENSE Q 36 2Q 7 MANHOLE REFERENCE UPPER
Vll �iI / LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TOJOO
CUflB PL Ml TOPL
PUBLIC SEWER F $ 5 00SM C-TAW--3UfISXTE-M7-W }
PC NO y
PITS AND/OR GRAINFIELD (I $1 a 00MP NO JOB HO O
HOUSE SEWER CONNECTING TOK PERMIT NO ROAD PERMIT NO v
PRIVATE DIS F MAL SYSTEM P 5 3 00
CONNECT ADDITIONAL BLDGAVIT 04111114,....I RLCORD INIITR NO DATE �
WORK TO HOUSE SEWER G $ 3 00 O
*EWER OR DISPOSAL SYSTEM C $ 3 00 YrV!
ORST WIDENING 0.
EKTN CESSPOOL MANHOLE C S e 00 N
ENCROACHMENT Z
PERCOLATION TEST P S 5 00IT NO
STRIAL
���}{.p E APPROVAL
OWNER'SC AR EB
PERMIT sAUTHORIZATION TOTAL FEEECTION CHARGE FEE
IHAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FES
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PU SLIC SEWER APPROVALS DATE INSPECT [
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
IIEPTIC
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/O TARA BEEP PIT(Q)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 'TND/OR WIINFIELD
WITHALL COUNTY ORDINANCES AND RATE GWS REGULATING
PLUMS[NO AND SEWERS CESSPOOL I- DRYWELL El
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOB ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE
A ESS [DBIDENTIAL PRZF[ Y ,
ABANDON HOUSE SEWER
IIIOERM
OFF PCRMITT SEEP PI L BMET TANKS ❑
f[CP PITIS) ❑ CESBPOOLB
OVALIDATION
CN M O CMM
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