HomeMy Public PortalAbout5129 SULTANA AVE_Sewer__ cetptAPPLICATION FOR PERMIT _
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPAHTblENNT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVL4ION FAR-.
5129 S T
WMA
LAMBS, Ce ty E.q oar
WdL1AM A )ENGEN, Sup 1 of Buil q C v
LOCALITY
FOA APPLICANT TO FILL INLEGAL
DESCRIPTION LOT NoR. PETERSON
pLOCK TRACT "' 4021 PECK
N15 OF
SIZE OF LOT NOW ONpLOSS LOT CITYEL MONTE T[L NO
UB[ or
BUILDINGS DISTRICT NO GROUP MAP P [SSCD BY
pN PO
CONTRACTOR TONY PIPELINE CONST ,3''p
ADDRESS708 NEW DEPOT 9T. CONNECTION DATA
CIT;,09 ANGELES
Q T[L NO STATION DEPTH
REGISTRATION NO (86 COUNTY MANHOLE
P� /' � LOOWW[RR_
1 No DESCRIPTION OF WORK RS }
ROUSE SEWER CONNECTING TO oo Y TYPE OP CCURB�ION L MCN TOP LOM
1. PUpLICEEWER O to oo
SEPTIC TANK SEEPAGE PIT OR P C NO V
PITS AND/OR DRAINFICLD 8 [1000 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAM P[PMIT NO O
CONNECT ADDITIONALTo
DISPOSAL SYSTEM Q Sam
1 WORKTo HOUSE.EWE R []00 3000 AFFIDAVITRgvo LV["[Rl RECORD INSTR NO DAT[
OVERFLOW..EAAGE PI DRAI ICLD lA
EKTN CESSPOOL DRYW L MA OL[/ tp OO Z
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL BYSTEM 0 S OO STAT[ENCROACHMENT
PERMIT NO
INDUSTRIAL
�T�[��ELp� - WASTE APPROVAL
O.��Sa� S PERMIT t 21 00 CHARGES
AUTHORIZATION TOTAL PEE CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON "EIMSURS[M[NT FEE
TRACTOR TO CONNECT TH[ ABOVE DCSCRISED 16 l[tS}�p _
TO THE PUBLIC SEWER ApppO�IA� DAT[ X CT .BIO NATIRE
SIGNED THIS DAY OF I9
OWN[11OR NEW HOUSE SEWER
OWNER.AO[NT COMX[CT ADDITIONAL
ADDRESS BUILDING ORWORK
-
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SCEP PIT(Q)
AND STAT[ THAT THE ASOV[ IS CORRECT AND AGREE TO COMPLY AND/OR GRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
1 H[R[pY CERT TM AM PROPERLY REGISTERED AMD/OR ALTER REPAIR .EWER OR
LICEN.[D AB EO Y OLDS CO TY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA O THA 1 A T [ P AND INTEND TO
DISCONNECT PLUG AND
RESIDE IN TM ABO D CR EO R ID NT PROPERTY ABANDON HOUSE SEWER
SIGNATURE ❑
of PERMIT IIS f L I BACKFILL SEPTIC TANKS ..
SEEP PITI.1 ❑ CESSPOOL.
VALIDATION ROBERT A WOOD -
CK M G CASH SUPERVISING MECHANICAL ENGINEER
_ _ _ LIC0 6 0 7 9M FEB 2 8 1 0 D 1 0.00- Nv