HomeMy Public PortalAbout5092 SULTANA AVE_Sewer__ 1
T°A°AR. ..
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CSS°. APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY RNGDNPEIII
BUMMG AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. T RUM C° tr Lngfi w Vol
CA@BRTf TA GRIPPER. Mny4 of Ran dInM LOCALITY
FOR APPLICANT TO 0 NEAREST
CROSS 9T
LEGAL
DESCRIPTION LM NO OWNER1019 '
BLOCK TRACT _ 3 NAIL
DRESS
10 OF BLDGS
SIZE OF LOT NOW ON LOTTEL NO
USE OF s
BUILDINGS DISTRICT NO GROUP YAPS P OCESSED BY
_ r B[ PO
CONTRACTOR ✓ 1
ADDRESS COIMCIION DATA
CITY p0 (7 STATION DEPTH
�-7 STATE MAAtlOLfi RfiFESfiRCM UPPSR
REGISTRATIOR NO C OUNTi LOWER
No DESCEEWWRIgFq R FIX
PUBLICSSENERCONNECTING TO 49 !00
SEPTIC TANK SEggPAAGEE PIT OH TYPE OF CO CTION LENGTH FROM
PITS AND OR DRAINFIELO S DO T CURB P ■ L TOP
OVERFLOW SEEPAGE PITTDRAINFIELD `
EKTN CESSPOOL DRYWELL MANHOLE 100
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 100 CO IMP NO JOB NO
CONNECT ADDITIONAL,BLDG OR TRUNK PERMIT NO ' ROAD PERMIT NO
WORK TO HOUSE SEWER 1 00
!EWER OR UA➢P08AL 9TSTbY HOUSE 1 00 STATE ENCROACHMENT '
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CtlAR0S8
OWNEWS PERMIT DO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL PES REIRBURS@YENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HERmR NAMED CON APPROVALS DATE INSPECTOR 3 SIGNATURE
TRACTOR TO CONNECT fi ABOVE DESCRIBED EXISTING DW0. NO
TO THE PUBLIC S i
SIGNED THISA OF Iy NEW HOUSE SEWER �I
OWNER OR CONNECT ADDITIONAL'
OWNERS AGENT BUILDING OR WORK
ADORP� SEPTjC TANK SEEP,PITS)
ST 0R DRAINFIEW
1
HEREBY ACKNOWLEDGE THAT 7 NAYS READ THIS APPLICATOR
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRTW LL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING A 7 REPAIR SEWER OR
PLUMBING AND SEWER! SEWAGE DISPOSAL SYSTEM
I MEREST CERTIFY THAT I AM PROPERLY REGISTERED APD/OR DIS CONNECT PLU G AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLHOUSGAND
CALIFORNIA OR THAT 1 AN THE LEGAL qgM OF THE ABOVESEWER
DESCRIBED RESIDENT PMOPEBTT. BACKFILL SE C TANKS❑
BIGRATURE D PITS CESlPOOL7
OF PERP
0. �MMATION ROBERTA WOOD
OS. ■ G. GMM SUPCEVI/ING MMCNANICAL.MNGINMMR
LAC05 6'5',8 R OR 24 1 0 A '55.00