HomeMy Public PortalAbout5102 SULTANA AVE_Sewer__ APPLICATION FOR PERMIT
DIVISION OF BURMING AND SAFETY SEWER—SEWAGE DISPOSAL
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WM J.FOX.COUNTY ENOIN�i ADDRE59
CA"ATTo aRIMN,BUP'TOFBUILDING LOCALITY Temple Cit.
LEGAL
FOB APPLICANT TO ML IN RQr
!T a at land
DESCRIPTION LOT NO OWNER
BLOCK TRACT ADDRfiS! 57(1!7-Sp 'RATA
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY amplA flfiTEL NO _
USE OF'
BUILDINGS DISTRITr GRO� YAP
BK PH
CONTRACTOR Soh N B c 7hanan
ADDRESS 13244 E. Ramona CONPEGTIox DAT
CITY Baldwin FarkTEL No ED-74213 STATIo DEPTH
CK STATE MANHOFERENCfi PEER
REGISTRATION NO 121537 ❑ COUNYT LE E
LOWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CO ETION LENGTH OM
PUBLIC SEWER S S SO Y CURB P L Y L P L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 2co
CONNECT ADDITIONAL BLDG OR C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 GO TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACNYBN
ANO/OR DISPOSAL SYSTEM too PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD /2 00 INDUSTRIAL
CESSPOOL
SCSPO C-W"l)NbGNiY 3 00 WASTE APPRO L
CHARGES
S acial conditions. oniv
O�8 PE, CO ECTION CHARGE FEE
$ -11 00
AUTHOUZATION I TOTAL FEE QD R[IMBURSEMENT FEE
TRACTORHAVE THIS DATE To CONNECT THEAABOVEWDESCR BED QESTIN6A DWELLING APPROVALS DA E INSPECTOR! GNATURZ
TO THE PUBLIC SEWER
f
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT bVIL01N6 OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND !EWERS SEWAGE REPAIR
DISPOSAL 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUbE BEWER
DESCRIBED RESIDENT IA PROPERTY BACKFILL SEP IC TANKS
EIONATUf'.
SEEP PITS CESSPOOLS
OF PERMRfiITTEE
WILLIAM J F&X COUNTY EN61NecR VALIDATION R A.WOOD.CHIET PLBa INBPB:cTOR
.IA687776 JUL 31 4 600 to
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