HomeMy Public PortalAbout5466 SULTANA AVE_Sewer__ TpApuD APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGMEER
BUILDING AND SAFETY DIVISION BUILDING
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IOH[f A LAM M County Evq�Dter
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LOCALITY
NEAREST
FOR APPLICANT TO FML IN C, 58 STLEGAL
DCDCRIPTION LOT NO OWNER T-
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7 74 MDIL
BLOCK TRACT pjrf( CCT w" A 1
NO OF SLOGS
BIZ[ OF LOT NOW ON LOT I. • T TEL NO
UB[ 01 DISTRICT NO GROUP MAP Pfl SED BY
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REGISTRATION NO LZ-([^ COUNTY MANHOLE REFERENCE JnQ• I YJ M,
No DESCRIPTION OF WORK FEE PE OF N P�7 LENGTH FROM
HOU{e SEWER CONNECTING TO Y PL ML TOPL 3 r
PUBLICBLWCR C $5 GO
{[PTICTANK { [PAO[PIT OR PC NO d
PITS AMD/OR ORA INFIELD B [1000 CO IMP NO JOB NO O
HOUBL{EWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NOv
PRIVATE DISPOSAL SYSTEM Q {B DO BE
CONNECT ADDITIONAL SLOG R AFFIDAVIT RMT[ TA.ER..T RECORD INSTR NO ,DATt O
WORK TO HODS[SEWER O 43M
OVERFLOW SEEPAGE PIT GRAINFIELD
[ETN CESSPOOL DRYWELL MANHOLE O SS DO HWY OR BT WID[NIM' d
ALTER R PAI ARGON US[ N
{CW[w OR DISPOSAL SYSTEM O 3 DO STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WAST[APPROVAL
OWNERR s S PERMs 00
CONNECTION CHARGE iC[ CHARGES
AUMORMTION TOTAL FEE
I HAV[ AT THIS DAT[ A CONTRACT WITH THE H[R[IN NA M[D CON REIMBURSEMENT IE[
TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S[W[R APPROVALS DATE INSP O SI'MATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT'ADDITIONAL
wDOR[tB BUILDING OR WORN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/'BKPTIC TAXA Bt[P PIT IS)
AND/OR GRAINFIELD
AND {TAT[ THAT THE ORDINANCES
IS cAMP S ANO LAWS[ E COMPLY
WITH PALLLUMBING
COUNTY OROINANC[{ ANO STAT[ LAW{ REGULATING CESSPOOL ❑ DRYWELL ❑
PLUMBING AND SEWERS
1 H[.ESY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR ALTER REPAIR SEWER OR
LICENSED AS NEOUIRZD BY LOS ANGLES COUNTY AND BTATE OF BEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEDAL OWNER AND INTEND TO [BACKFILLSEPTIC
$CONNECT PLUG AND
fl[910C IN THE ABO E+O68CI(Ip[ R IOLNTI PROPERTY ANDON HOUSE SEWER
p IONATUR[ /R/��
01 P[RMITT£E ✓ TANR9 ❑EP PIT(S) ❑ CESSPOOLS
ALM TION ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENGINEER
L�o 0 5 4 8 Z9 MAR 16 1 O D 7.00- W
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