HomeMy Public PortalAbout5328 SULTANA AVE_Sewer__ 6AU2 °°'
7BAMID APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL'
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 'l
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PUBLIC SEWER O saw
bEPTIC TANK BIEPAO{PIT OR P C NO V
PITSAND/OR GRAINFIELD O [1000 CO IMP NO 377 JOB MO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O
PRIVATE DISPOSAL SYSTEM O [e 00
CONNECT ADDITIONAL BLDG OR AFIIDA IT YMu p[[uat RCC RD INS NO OAT[
WORKTO HOUSE SEWER O SS OO O
OV[RPLOWS[QPAO[PR ORAINFICLO T• t/)
EITN CESSPOOL DRYWELL MANHOLE O [BOOICOMPLY
HWY OR BT WIDENING
ALTER FIPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYET O {S 00STAT[ENCROACHMENT
PERMIT NO
INDUSTRIAL
WAST[
APPROVAL
CHARGEE
OViR1ER'3 PERMIT o0
AUMOFMTION TOTAL FEF CONNECTION CHARD[FE!
I HAVE AT THIS DATE A CONTRACT WITH THE HEREICON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E%ISTLLINO _
TO THE PUBLIC SEWER APPROVALQ SATE INSP[CTO SIGNATURE
SIGNED THIS Dp�AY/OF18_
OWNER OR - �¢ V v
NEW
HOUSE SEWER
OW NKRS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIATION SEPTIC TANK plEl PIT(S)
AND STATE THAT TH[ A[OVE IS CORRECT AND AGRMPLY AND/OR DflA1NFIELp
WITH ALL COUNTY ORDINANCES AND STATE LAWATINGPLUMBING AND SEWERS CESSPOOL ❑ DRYWELLIHEREBYCERTIFY THAT I AM PROPERLY REGISTO/OR ALTER REPAIR S[W[ROR
LICENSED AS R[OUIREO BY LOS ANGLES COUNTY TE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA Oq THAT I A TH[ LCOAL OWNfR OF AND TO OISCONN[CT PLUG AND
RESIDE IN THE ADO VH CRIBIO RESI MTIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE pAKPILLSEPTIC TANK{ ❑
SEEP PIT(p) ❑
CESSPOOLS
VALIDATION ROBERT A WOOD
cKK M D CASH SUPERVISING MECHANICAL ENGINEER
LAC62277C2 NOV 610 D 5.00~