HomeMy Public PortalAbout5078 SULTANA AVE_Sewer__ � 24650 INUM -
oaeoee so
YeAeeto APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWERSEWAGEDISPOSAL.., 1
DEPARTMENT OF COUNTY ENG MM
BUILDING AND SAFETY DIMIONBUILDING
ADD RE38 507A sultana,
UA �,=p $EiTjd.W LOCALITY Temple Cit
INEAREST
FOR APPJICANT TO FILL IN ROSS ST
LEGAL
DESCRIPTION LOT NO\LM 5 /OWNER Gene Rislin
BLOCK CT I,"� ` , MAIL
ADDRESS 080 Sultana
NO OF SLOGS C 11 O
SIZE OF LOT NOW ON LOT CI 64
USE OF
BUILDINGS DISTRICT NO GROUP I
�M YAP PS CE338D BY
CONTRACTOR William F Lumble 5/D(A
ADDRESS9nn CONNECTION DATA
CITY El Monte TEL NO Gi 97455 STATION DEPTH (
STATE MANHOLE REFERENCE l`27e25 S. Upper UPPER
-
No
NO COUNTY LOWER
No DSEESCRIPTI WD FEE
PUBLIC SEEWWERCONNECTING TO SS 00
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM
PITS AND/OR GRAINFIELD S `T CURB P L Y L 70 P L
OVENFLeW 9PEPAGE PITEGRAINFIELD SZoo 3 HOUSE SEWER SEWSP CON SY`RT NG TO P 0
��qqLL N SI 00 C P NO JOS NO
Z WORK TO HOUSEISSNEBLDG OR OO TRUNK PERMIT NO ROAD PERMIT NO p
A TERREPAIR OR ABANDON HOUSE 100 STATE ENCROACHMENT M
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHAR6
OWNER'S PEIiA'IIT 2 00 CONNECTION CHARGE FEE
AumonmATION F TOTAL FEE 3
OO REIYBURSEYENTFIMI HAVE AT
TRACTOR TO CIS DATE A ONNECT THE ABOVE ESCRIBED EXISWITH THE TN NAMED ING NG D FLUNG APPROVALS DATE rINSPECT,ORSSIG
NATURE
TO THE PU SLI S ESIGNED THI DAY OF B� NEW HOOSE SEWER-
OWNER OR '1 CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDR AND/OR GRAINFIELDIHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
DISCONNECT PLUG
PLUMBING AND SEWERS ALTER REPAIR SEWER SEWAGE DISPOSAL E -
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED ANDAND
LICENSED AS REQUIRED BT LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT A THE LEGA OWN OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDGHTIA P P RT) BACKFILL 9E CYAN KS
SIGNATURE f SEEP PITS CESSPOOLS
OF FERN ITTEI, " =�&
mP ATION ROBERT A WOOD
�• ■ y ....e SUPERVISING MECHANICAL KNOUSIMM
�lALo 6 0 9 4 APR27I O D 3 .0 0 e