HomeMy Public PortalAbout5515 SULTANA AVE_Sewer__ TBA S4;D - CE808 - 9/73 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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OWNERS PERMIT CHARGES —
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I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED COM REIMBURSEMENT F[[
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING A OVA
TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF IG_
OWNER OR N[W HOURS SEWER
OWNERS AGE NT
CADDITIONAL
ADDRESS
BUILDING OR WORK
I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK BEEF PITS)
ANO/OR GRAINFIELD
AND STAT[ THAT THE ABOVE IS CORRECT AMp ACR[C TO COMPLY
WITH ALL COUNTY ORDINANCES AMD STAT[ LAWS REGULATING
PLUMBING AND SEWERS EDA
❑ ORYWELL ❑
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORAIR SEWER OR
LICKNEED AS R[OUIRED BY LOS ANGLES COUNTY AND STAT[ OFISPOSAL SYSTEM
CALIFORNIA OR THAT I AM TH[ LEGAL OWNER OF AND INTEND TOT PLUG ANO
R[Slp! IN TX[ ASOV[ DESCRIBEO RTU" q[SID[NT L HOUSE SEWER
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