HomeMy Public PortalAbout5454 SULTANA AVE_Sewer__ APPLICATION FOR PERMIT
COUNTY OF LW ANGEM i SEWER-SEWAGE DISPOSAL 1
DEPARnMa OF COUNTY EN6Uffi
BUILDING AND SAFETY DIVISION
BUILDING
DD EIN
SS /i•/✓ V
CAMSETi D OffiFFk 11 d Sadinp LOCALITY
NEAREST
OH TO — CRO ST
LEGAL
DESCRIPTIO NO DITHER //lio�✓�
BLOC[ 16 TRACT ADUAIDREE! ..i ✓-�'
SIZE OF LOT No
NOW ON LOTNO OF LO
! CITY OS ' D)CO
USE OF
B ILDIRG! �'� DISTRICT NO GROUP YAP PROCESSED BY
CONTRACTOR BE M
ADORERS T—' CONNECTION DATA
CITY TEL NO O � �Od DEPTH
3 CGUTE A ROLE REFERENCE
REGISTRATION NO R
No DESCRI O R FEE
HOU! 9ET�Eg�I CONNECTING TO
PUBL�C SELLER ® !00 TY
OF CONNECTION' LENGTIIMM
SEPTIC TANK SEEPAGE PIT OR T CURB P L Y L TO P
PITS ANO O I DRAINFIELD 00
OYERFLOW SEEPAGE PIT DNAINFIELO
Na S2 go
HOUSE SEWER CONNECTING TO P C NO
PRI STEP f CO IMP NO JOB XO
CONNECT AODITIONALRS LOG OR TRUNK PERMIT NO ROD PERMIT NO
WORK TO NODU!IEE SSEEWWEN
A T R AEPA1 OR ABANDON HOUSE STATE ENCROACHMENT
DISSA L ByI00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES '
OWNERS PERMIT g CONNECTION CHARGE FEE
AUMOMATION TOTAL. FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING AMO DATE INSPECTOR 9 SIGNATURE,
TO THE PUBLIC SEWER I
SIGNED THIS SAY OF Y_ NEW xouEE SEWER I-3y
OWNER OR /J� CONNECT ADDITIONAL
OWXERSAGENT 1/ BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(9)
AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE RED THIS APPLICATION
AND !TATE THAT THE ABOVE 19 CORRECT AND AGREE TO COYPU CESSPOOL DRYWELL 11
WITH ALL COU HTY OHDINANGE9 AND STATE LAWS REGULATING
PLUMBING AND SEWER! ALTER REPAIR SEWEROR
SEWAGE DISP09A STEP
1 HEREBY CERTIR THAT 1 AN PROPERLY REGIBTERlD AMD/OR DISCONNECT PLUG AND
LICENSED A3 REQUIRED BT LO! ANGELE7 COUNTY AND STATE OF ABANDON HOUSE!EWER
CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF TNS ABOVE /
DESCRIBED REND T L PROPERTY AC FILL EP 8E CCESS(S 00� O n �/
SIGNATURE
OF PERYITTE
m• VALIDA OROBERT A WOOD
R J
■ 0. GAStl DUPEFTVIGINO NHCNANICULL BNOINMMIL
LA0 4 5 7 7 DEC 21 1 0 A 5.0 0 10
� �l7
1 1 -
r.
1
APPLICATION FOR PERMIT
cnGar 7
COUNTY of Los ANaEtea SEWER—SEWAGE DISPOSAL i
DEPA87M@R OF COUNTY ENGINEER
BQU.DDQG AND SAFETY DIVISION eD1 LDINo C
ADDRE877
CA8861T D OCIPPQr,8�t d D°Ddlep
LOCALITY
NEAREST G
FToR UIP�nMiCAWMMZO CROW
LEGAL
DESCRIPTIO M ipl1wOWNE
BLOCK TRACT I RAIL Qw
ADD ���
NO OF BLOT!
SIZE OF LOT NOW ON LOT CIUSET
DI DISTRICT NO GROUP AP YPROCESSED BY
UI OF
BUILDINGS
UI .�-�
W
CONTRACTOR
ADDRESSoll
r CONxEcrION DATA
CITY Te
TEEL NO 60 [ALO DEPTH
REGISTRATION NO % dIf
COU'NTT OlE IEFE LOWER
NO I
11DSESCR PTI W FEE
PUBLIC 9E41'EERCONNEGTING TO op !00
CONNECTION LENGTH FROM
SEPTIC TAANK SEEPAGE PIT OR TYPE OF 7
PITS AND/OR DRAINFIELD T CURB P L Y L TO P Y
OVERFLOW SEEPAGE PIT DRAINFIELD
DR
HOUSE EWERCONNECTING TO P C NO
�I111II TP ASSp 73 �11S�YL CO IlP NO JOB NO
WORK TO XOUl HISEWER LDG OR .00 TRUNK PERMIT NO ROAD PERMIT NO
A T fi AIR OR ABAND N ROUSE STATE ENCROACHMENT
ISPOALSYST100 PERMIT NO
INDUSTRIAL
WASTE APPROVA
CHARGES
OWNEWS PERMIT CONNECTION CHARGE FEE
AUTSORMAEON TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH YXE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED 4ISTING DWELLING APPROVALS I DATE I NSPECTOR 3 SIGNATURE
TO THE PUBLIC 3E,1 EEL
SIGNED THI AY O NEW HOUSE SEWER
OWNER A CONNECT ADDITIONAL
OWNERS R BUILDING CONNECT
D WORK
f JI
ADD SEW?TICTANK SEEPpP1T(S) `
I HEREBY ACKNOWLEDGE THAT I HAVE R THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRTWEL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR !EWER OR
PLUMBING AND SEWERS ALTER EPAIRDISPOS SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BT LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AR THE LEGAL 0 NEB OF THE ABOVE ABANDON ROUSE SEWER
DESCRIBED REBID PROPEBTT ISIEEP LLfE C
SYANKS
IGNATURE PEEP PITS CESSPOOLS
OF PERRI
of VAL *,—, ROBERT A WOOD
QIS.9 SUPERVISING MRCHA
RNOINRRR
LJ&4578 $; DEC 2111 A 2 5.0 0
if�0 �