HomeMy Public PortalAbout5611 A & B SULTANA AVE_Sewer__ LEEDBIREV ° E. APPLICATION FOR PERMIT.
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DIS"IRICT NOGRDUP MAP SED BY
HK PG •
eulLDlnG O
ADORESE � L r' ♦�U
LOCALITY L$- � T
NNECTION DATA
NZas sr 4�' rW d/ f arwnoN Q, ef
DEPTH
�FEc
OWNERO lopar- al
MANHOLREFERENCE OWER
E
MALL TYPE OF CCUttb� MLO pLENTH PLROY
AOORESS S(j 5• QS Y RB
&J CO IMP NO 3 7-v �P'a o I ?
' LSDAL TRUNK PERMIT NO ROADPERYITNO
DESCRSRION LOT NO
�/ rY AFFIDAVITWAIVER EASEYEer RED IneTR NO CORDATE
BLOCK TRAtt V
OF SLDOS
S�OFLOT Q O WONLOT HWY OR ST WIDENING
USE OF
BUILDINGS PSTATE ERMIT NCROACHMEM
PERMITNO
GOnTRACTOR INDUSTRIAL '
WASTE APPROVAL 1
' CHARGES
ADDRESS
CRY Z TEL NO CONNECTION CHARGE PCB
STATE LIO RBIMBURSEMBNTFEC i
LICENSE NO CLASS /
NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR S SIGNATURE
HOUSE SH W BR CONNECTING TO
PUBLIC SEWER
SEPTIC TANK SEEPAGE PIT OR
NEW House Sewell —
POUSIESE ERCONNELD CONNECT OR WORnAL
HOUSESEWER ALSYSTEM TO SUIDING OR WORK
PRNATEOIS DITTOLO SEPTICTANK SEEP PITISI
CO RKTO H USM SEWZR OR MID/OR DRAINPIHLD 1 .
' WORK TO HOUBl66WER
OVERFLOW SEEPAGE PIT DRAINFIELD CESSPOOL [3 DRYWELL❑
EXTH CESSPOOL ORYWCLL.MANHOLE _
ALTER REPAIR ORABANDON HOUSE ALTER REPAIR BCWEROR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
w DLSCONNECT PLUG AND -
AeANDONHOUSSSEWER
BACKFILLSEPTIC TANKS LJ
OWNER'S
Permit S Heap PRISI❑ CESSPOOLS❑
AUTHORIZATIO14=1 TOTAL FEE VALIDATION
I HAVE AT THIS DATE A CONTRACT WITHTHE HEREIN NAMED LGN - :9 6 9 a A
TRACTOR CONNECT THE ABOVE DESCRIBED
WE
EXISTING OLLINO
TO THE PuBLsLK:EEvrew
SIGNEDTHIS DAY OF 19� # E • • • 0
OWNER OR
OWNERS AGENT -' 2.0 S•1Sp
ADDRESS oo ••
I HEREBY ACKNOWLEDGE T I HAVE READ THIS APPLKATIGN " ' • S S I a O O 5
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -'I-QO2-79
I-^ O —
PLUYBINGANDSEWERS
1 HSREBY CERTIPY THAT 1 AM PROPERLY R[OISTERSD AND/OR
LICENSED AS REQUIRED Ily LOS ANGELES COUNTY AND STATE OF
CAI_IPORNIAOQTHATIAWWHELZGALOWNffROF ANDINTENOTORS
SIDS IN THE ABOVE DE IBRD RlSIDCNTULL PROKRIY -
SIGNATURE - -
OP KRMITTE■
J o —o.ST323 - - • - - --