HomeMy Public PortalAbout5046 SULTANA AVE_Sewer__ 'good°'
cuoe a ae APPLICATION FOR PERMIT.
COUffff OF Los ANGE= SEWER—SEWAGE DISPOSAL
DEPAHTBOM OF COUNTY ENGOM
NUBJUNG AND SAFETY DrMON BUILDING
TORN A. •UO �tz ADDRESS
CABBAti D GH111705,BW i e7 BundinS LOCALITY
N EA:SM
O CROS!ST
LEGAL
OfiSCRIPTION LOT OWNER
MAIL
BLACK TRACT �, 'i ADDRESS
NO OF BLDG$
SIZE OF IAT NOW ON LOT CIT NO
USE OF
BUILDING! DISTRICT NO GROUP YAP PROCESSED BY
BK PG
CONTRACTOR IERCONST.CO.
ADDRESS 1317 COLEGROVE AVE c CTs N DATA Ij
CITY MONTEBELLOTEL No 1. STASTATION DEPTH
REGISTRATION NO 180767 STAT COUTNTY ■ANHOLE REFERENCE UPPER
No DESCRIPTIO F WORK FEE
HOUS SEITER CONNECTING TO
PUBL C SERER S 00
SEPTIEaT1lNK SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM �{
PITS AND ON GRAINFIELD S 00 T CURB P L Y L 70 P L V
OVERFLOW SEEPAGE PIT DRAIN
EZTH CESSPOOL DRYWf'LL MANHOLE 2 00
HOUSE SEWER CONNECTING TO '' nn,�{{ P C NO
PRIVATE DISPOSAL SYSTEM 100 IMF NO,2,& - JOB NO
CONNECT ADDITIONI�k1�BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
W��O77REEK TOHOUSE8EWER 1 00
REVIEW OR DI8PO4AL ABANDON
HOUSE 1 STATE ENCROACHMENT
00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNM PEOUT 2 00 CONNECTION CHANGE FEE
AUTHOMA17ON TOTAL FEE REIMBURSEMENT PER
1 HAVE AT THIS OATS A CONTRACT WITH THE tlQE1N HAYED CON APPHOVAIS DATE INBPECT00.S SIGNATURR
TRACTOR TO COKNECT THE ABOVE OEBCBIBED Qf4TlNG DYfELL1NG
TO THE PUBLIC SER
SIGNED THI Y OF A 19,9N NEW HOUSE SEWER
OWNER OR �1\ CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PITH
ADDRESa AND/OR DRAINFIfiLD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTA REPAIR 9fiA'ER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AflD/OR DIS CONNECT PLUG AND
LICENSED AS REQUIRED BY LOS GELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR 1 ■ 7 GAL OWNER OF THE ABOVE
DESCRIB REST BO BATYKE
CRFlLLe
SIGNATURE l CE99PODLJ � C
OP P RYI
OF VALIDATION ROBERTA WOOD
ca ■ G cum S UPUMSING MECHANICAL @1GINEYR
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