HomeMy Public PortalAbout5546 SULTANA AVE_Sewer__ CESOB
76A64BA2D 0-63 APPLICATION FOR PERMIT_�lez49
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPAATKENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDIN
-�O•E4_7--A LAMBEE Cpppty EB w ADDR ESB (J
WMA "mmm Sup t DI BUII V LOCALITY Q
NEAREST
FOR APPLICANT TO FILL IN "0" ST
/9 v F/�
DEpLLedAL0N LOT NO , OWNER L'?
/ NAIL
BLOCK TRACT ADDRESS
NO
SLOGS
[IS[ OF LOT NOW ON LOT CITY TEL NO
Us[ OF
[pILDINOS DI1TRICT NNOOOHOUR MAP P. PROCESSES BY
!IU • hF' �BK //
CONTRACTOR /
ADDRESS CONNECTION DATA
CITY 9� A/f. IY IT TEL NO of 6 STATION DEPTH
�) COTH UPPER
REGISTRATION NO pC O UNTY MANHOLE REFERENCE
NO DESCRIPTION OF WORK FEE TYPE OP CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURD P L M
PUBLIC SEWER • ss GO
SEPTIC TANK SEEPAGE PIT OR P C NO d
PITS AND�OR ORA
INFIELD d slo 00 CO IMP NO JOS NO O
HOUSE SEWER CONNECTING TO TRy MIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM 0 SS GO C
CONNECT ADDITIONAL BLDG OR AFFIDAVIT [uu,RT RECORD INS" NO DAT[ O
WORK TO HOUSE SEWER 0 $300 �P
OVERFLOW BKKPAOE PIT GRAINFIELD
[ETN CESBPOOL DRYW[LL MANHOLE 0 $3 W RWy O ST WIDE IND
ALTER REPAIR R ABA SON HOU [
BOWER OR DISPOSAL SYSTEM O S 00 N
STATEENCROACHMENT
PERMIT
PERMIT NO
INDUSTRIA
WANTS APPROVAL
CMARO[S
OWNER'S PEBMR' s s o0
AfTPV 1LC�OFMTION TOTAL FEE CONNECTION CHA F[E
1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON R[IMpU [NT FSS
TRACTOR TO CONNECT THE ABOVE DESCRIBED 6IISTIHp DWELLING APPROVALS
TO THE PUBLIC SEWER DAT[ INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 18_
OWNER OR NEW HOUSE SEWER
OW N.RS ADEXT
CONNECTADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP PIT IB)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STAT[ THAT TH[ ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING ❑
FLU MSINO AND SEWERS CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND�OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUN O ST TE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM TH6 LEGAL OWNC AN ND TO DISCONNECT PLUG AND
fllSIDE IN
THE
A IS[ SID[N AL FROPE ABANDON HOUSE SEWER
SIO, PERM[ BACKFILL SEPTIC TANKS ClSEEP PIT($) LI C[BSPOOLe
OVAIMATION ROBERT A WOOD
CK M G CASH SUPERVISING MECHANICAL ENGINEER
UAL04 4 8 9—W OCT 2 1 0 D 5.00^' tv