HomeMy Public PortalAbout5079 SULTANA AVE_Sewer__ 76A"2D°' APPLICATION FOR PERMIT
COVNTT OF LOS ANGELFm SEWER-SEWAGE DISPOSAL
DEPARTMW OF COMM ENGRffER
BUILDING AND SAFETY DIVISION BUILDINGADDRESS
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DESCRIPTION LOT NO OWNER
BLOCK TRACT RAIL
ADDRESS
0 OF SLUGS
SIZE OF LOT NOW ON LOT CITY TEL -Q
UDE OF
BUILDINGS ezlo DIDTRIC7RO ROU YAP PROCESSED BT
CONTRACTOR (I
ADDRESScrt CONNECTION DATA
ITY
CNO STATION DEPTH
REGISTRATION NO COUNTY
MANHOLE REFERENCE P
No II D1gEgSCRIP O F FEE
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PUBLIC V CONNECTING TO 00 �5- M
SEPTIC TANK SEEPAGE PIT OR ✓V TYPE OF CONNECTION LENGTH FROB
PITS AND/ORLRAINFIELD T CURD P ■LTOP
OPENFLOFW SEEPAGE PITDRAINFIELD 00
a
P0 EWER COMXEttI 0 TO P C NO O
RIVATE'N11g A 7 ��T1, 9 3100 CO IMP NO O O JOB NO V
1C o" TO XOUDSE IIOMR OR 1 TRUNK PERMIT NO ROAD PERMIT NO p�
A TER ER REPAIRO BANDON NOUBE 100 STATEENCROACHYENT O
PERMIT NO IlL'
INDUSTRIAL
STE APPROVALL
N
CHARGES ?
OWNER'S I PEVaT 31 $ 00 CONNECTION CHARGE FEE
AUMOMAITON I TOTAL FEE REINGURSFOIENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE MEIN 11® CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED ]POSTING DWKI,PNQ AMOV= JdAW I INSPECTOR a RB
TO THE PUBLIC SEWER
SIGNED THIS DAY IB_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OP WORK
SEPTIC TANK SEEP PIT(S)
ADDRES! AMD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAYE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWEL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGOLATING
PLUMBING AND SEWERS ALTER REPAIR SEWEROR
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED ARD/OR SEWAGE DISPOSAL SYSTEM
LICE1438D AS REQUIRED BT LOS ANGELES COUNTY AND STATE OF 'DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AN THE LEGAL DIN ER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED SIGNATURE 6 E RElI BACKFILL lE CCTANKS
KSS y
ID BEEP PITS
OF PERMITTER
AIM ON ROBERT A WOOD
Q, ■ 0 cAFe GLIPMRIVISING MKCNANICAL pCaNBmE
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