HomeMy Public PortalAbout5110 SULTANA AVE_Sewer__ CUM' °a
TUBAaD OAPPLICATION FR PERMI
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION g=G
4a;4 a
WMALAMM C. EB BBr
A IENSEN 9uP i el H jIA_q
FOR APPLICANT TO IN GALDQICRIPiION LOTN BLOCK TRACT
NO O BLDG6
It
•IZE OF LOTl§W NOW ON LOT CITY TEL NO
U.I OF W"IK
T MO GROUP MAF PROCLBII BY
BUILDINGS
BK — ro
coNTRwcro
ADpw[.B co CTlON D TA
CITY 6L N /1 O[!TN /
E REFERENCE V
REGISTRATION NONO DISC ON O WORK P[¢ O Of CONNECTION LtN T PROHOUSE SEWER CONNECTING TOCURB L M L TO P L
PUBLIC SEWER 0 [a 00 PC NO
aePTIC TANK B[EPAGQ PIT OR CO IMP XO JOa NO
PITSANO/OR GRAINFIELD 0 .1000
HOUSE SEWER CONNECTING TO TRUNK RMIT NO RO T NO
PRIVATE DISPOSAL SYSTEM 93 OO
CONNECT ADDITIONAL SLOG OR 15-TATE
DAVIT B11T�• 1 OAT[
WORKTO HOUSES[W ER C t300
OVERFLOW SEEPAGE PIT DRAINFI[LD
EXTH CES.POOLDRYW[LLMANHOLCO $500
ALTER R PAIR OR ABANDON HOUSE OR IIT W1O[XIN6
.EWER OR DISPOSAL SYSTEM 0 [300 ENCROACHMENT
ITNO
STRIAL
T[APPROVAL
CHARGtS
OWNER'$ PERNV[ s !AUTHORIZATION TOTAL FEF NECTION CHARGE PEE
I HAVE AT THIS OAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DW[LLINO APPROVALS
TO THE PUBLIC SEWER DATE INOCTORSBIGNATURE
SIGNED THIS DAY OF Iq_
NEW HOUSE SEWER
OW NEfl6 AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADOR[ea
ERIC TANK SEEP PIT(G)
I HEREBY THAT
THE ABO THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THQ DIVA IS CORRECT AND AWS E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW. REGULATING
PLUMBIM6 AND SCW[RII C[a.POOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REOISTER[O ANO/OR ALTER REPAIR BEW[R OR
LICENSED ASO
S REOUIREO BY LOS ANGLES COUNTY ANO STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INT[NO TO OI.CONH[CT PLUG AND
wUIDL IN THE ABO DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE S[W[R
SIGNATURE BACKPILLBE"6 TAN" ❑ AI /
of P[flMrrr[ e[[P Prr 1II1 IJ c[eBPool.
VALMATIOROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENGINEER
LaLp 4 5 1 4 QI SEP 19 1 0 D 1 0.00- fj