HomeMy Public PortalAbout5076 SULTANA AVE_Sewer__ 4
CEeoeAPPLICA ION FOR P RMIT
TaAeA[0
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPAMEENT OF COUNTY ENGINM
BUILDING AND SAFETtYF DIVISION ,ADDpess E -
WII.I.IA A,A )t�7 o 1 4 Dml Kdmq
_ LOCALITY Cl
FOR TO CRM BY �
LEGAL
DESCRIPTION LOT NO OWNER S
BLACK TRACT IMIDDRESS s_a Q 5 �(✓ ,/Tv�
0 OF BLDGS
SIZE OF LOT MI ON LOT C
USE OF
BUILDING! DISTRICT MO GROUP BAP BY
CONTRACTOR
muss S (� C D CONNECTION DATA
Cm �, G. TEL No ,0 RATION -'oeFra'
REGI9TRATTOM NO STATESCOUNMANHOLE REFERENCE P
N 11�tla ERWI I N FEE
PUBLfC SEIT CONNECTING TO 00
PREOPTICT MK SEE PAGE PIT OR Ecolm!!Noi
F CO [ P L. LENGTH FROM O
PITS AMD OR DRAINFPOOL ORIELD
32.00
0 2100
OYERPLOW SEEPAGE PIT D�AINFIELD a
CC N11IS[ SISI EpR�C�O�N�N�LCTI G70 JOB NOo 0
4001 TO�XOUSKIIEY w, R TRUNK PERMIT NO MAD PERMIT NO O
ATR REPAIR OR ABAN M HOUSE STATE[NCROACNM[NT3100 r
SYSTPERMIT MO l�J
INDUSTRIAL a
WASTE APPROVAL1A
CHARGKII ?
OWLS PIMM CONNECTION CHARGE FE[
AUTHORMATION I TOTAL FEE REIMBURSEMENT FEE
I RAVE AT THIS DATE A CONTRACT WITH THE HEREINAMED CON-
TRACTOR TO CONNECT THE AMOVE DESCRIBED EXISTING DWELLING OV D TE/ IHSPKCTORSSIGKI¢01¢
TO THE PUBLIC nW®.
SIGNED THIS DAY OP 9_ NEW Hou[[SEWER l/
OWNER OR �1 CONNECT ADDITIONAL
OWNERS AGENT 1 BUILDING OR WORK
TANK SEEP
ADDR AND OR DRAINFIELDPIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CESSPOOL DRYW[LL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWAGE DISPOSAL SYSTEM
I HERE C TH T 1 AN PROPERLY REGI HD AND/OR DISCONNECT PLUG AND
LICENSED AS UIRED LOS ANGELES COUNTY 0 EFATE OF ABANDONCT PLUG HOUSE AND
CALIFORNIA THAT AV THE LE L OWNER F THE ABOVE
WER
DESCRIBED ID PROPERTYBACKFILLSE C TANK!
SIGMATUR SK[P PITS CElSPO0hj
OF PERM
VAIMATIOROBERT A. WOOD
CL It 0 (`fYs/f WPOiVIGINa MKCNANICAL DZi01NK=
Lf2327MAY 8 1 1 D 2500
1 L�7.AiiX/
CeaoeAPPLICATI N FOR PER IT
TeAa�xO
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGI!ffi
BUILDING AND SAFETY DMSION ADTLoInc
1O� A AODREss O
watue! A. IEne@t' BcP w _ LOCALITY G
H REST
F APPS IC CC SS BY �r
DESCRIPLEGATION LOT NO OW HEEST
R !N /
BLOCK TRACT RAIL ADDRESS
S080 A
NO OF BI !
slze OF Lar noW ON / TT
TTL Ila �47-
031 OF
B ILDING! DISTRICT NO GROUP RAP SY
ec ro
CONTRACTOR �� ✓E�a Cr
ADDRESS L/f}� CONNE ON DATA
CITY S S TEL NO STATION D[PfN
REGISTRATION NO COUNTY MANNOSE REFESU:NC[ UPPER
0 R N OF FEE
HOUSEC CONNECTING TO a Do
SEPTIC TT(NR SEEPAGE PIT O■ OP C LEXOTN FRO■
PITS AND/OR DRAINFlELD T P L ■ P
OVERFLOW S[EPAa PI DRAINFIELD 00 1
CCO�ISITEg EWAIEpRC771Op�M111N��LELL I GTO CO I■P NO e/C/Q JOB N OV
11RRK TO ODS SEWb?" RA 00 R TRUNK PERMIT NO [GAD PLR■R No O
A A 0 ARAN N")USQ STATE ENCROACHMENT r
PERMIT NO 1lYJ
INDUSTRIAL y
ASTZ APPROVALN
CHARGES 2
OWNM PERMIT 00 CONNECTION CHARGE FIX
AUTHORMA'IION TOTAL IFF COMREIMBURSEMENT FS[
I HAVE AT THIS DATE A CONTRACT WITH THE igcca-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING ADWELLING PI)MOV DATE/ INSPECTOR D SIGNATURE,
TO THE PUBLIC SEWER.
SIGNED THIS-------DAY� 9_ NEW HOUSE SEWER
OWN 0E CON M ECT ADDITIONAL /
OWNERS A0[■r BUI LOIN
OR WORK
ADDRESS SEPTIC TANK BEEP PI7(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIOR
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLT 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 A D/OR SEIIAGE DISPOSAL SYSTEM
LICENSED AS RQOUIRED BT ANaELL! COUMiT ANO ST [ OF DI SCONNQCT PLUG AND
CALIFORNIA OR THAT NL LEGAL OWN[[[���OP THE ABOVE ABANOOM OL SEWER
DESCRIBED RESIDEMTI RTT '/� BACKFILLS[ CT
SIGNATURE �/J SEEP PIT S
OF PERMS
V ATIO� ROBERT A WOOD
CL ■ 0 CASK SUPmlVISINO MMCHANICAL INOINffXR
UL2 3 2 6 MAY 8 1 0 D 7.0 0