HomeMy Public PortalAbout5617 A & B SULTANA AVE_Sewer__ iwaxO C//
CE 8N IREV °"!' APPLICATION FOR PERMIT
�I -
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELS_ BUILDING AND SAFETY
FOR APPLICANT TO FILL olmn NO GROUP MAP Essen BY
B r
BUILDING •QO
ADDR[an
CONNECTION DATA
LocALm
NEAREST STATION ?641
CROSS m
OWNER M _
ANHOL[R[FSpBNCC �� LOWER
YPE OF NICTq LENGTH/ROMUMNL / �• MLTOPLPC NO
_�yEg
W NO 7�CRY TELNO /tLEGAL KPERMITNO ROADPERMmNO
DESCRIPTION LOT NOIDAVR WAIVEp EASEMENT RECORD INSTR NO DATEBLOCK TRACCT YB>aOPLOT1OOX NO ONLOTNC, Or SORSYWIDENINGE ENCROACHMENTR NO CONTRACTOR STRIAL _TE APPROVALAOORESS CHARGES
CITY /' L TEL NONECTION CHARGE FEESTATE
LICENSE NO y Q CLASn � ONO DESCRIPTION OF WORK FE[ APPROVALS DATE INSPECT SIGNATU HOUSE SEWER CONNECTING TO
PURLIGSEWER[[PTICTANK{[EPAGEPITOR HOUSE 9EW8RPR9 AND/OR DRAINFI[LDNECT ADDITIONALHOUSE![W[RCONNECTINGTO ING OR WORKPRIVATE DISPOSAL SYSTEM /ORDNK BEEF PRIeICONNECTADOmIONALBLDG OR /OR DRAINFI6LD -
WORKTOHOU968EWER -OVERPLOWn6EPAG6Fm DRAINFICLOSPOL ❑ ORYWELL❑
EKTN CESSPOOL DRYV0V" MANHOLE
ALTER REPAIR OR ABANDON HOUSE ALTER REPAIR SEWEROR
n6WER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
` DISCONNECT PLUG AND
AMNDON HOUSE 8E W ER
BACKFILSEPTICTANKS❑ - -
Permit ! BEEP Pm1n1❑ CEBSPOLec
OWNER'S --
AUTHORIZATION TOTAL FEE - -VALIDATION - I
I HAVE AT THIS DATE A CONTRACT WITH THE HERS IN AM CON
TRACTOR TO CONNECT THE ABOVE DESCRIEED I
TOTHEPUBUCIIEWCR w1 - L D
SIGNEDTHIS - DAY OF Q 9/ - - V V
O eR OR / pp
OWNERSA - -_ m E 0 1 0
ADDRES! 2 P • 1 R O O
I HE Y ACNNOWLCDG AT I HAVE READ THIS APPLICATIONTHE ASO IS CORRECT pp
ANDTO COM�Y
ST
COUNTY ORO M ES AND ST/A�TEO LAWS EREGULATINO [ [ ! 1 O 0 0 iS
PWM HG AND SEWMR8 - _ �-
I ASSY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR
LICE ED An RHOUI O EY LOS ANGELES COUNTY AND STATE OF 1002-79
C ORNIA OR TH AM THC LEGAL OWNER OF AND INTCNDTO RE _
EIDE IN THE ABOV CRI.EORESIDENTUU_PROPER
SIGNATURE
�OF�PER'E
�/o -G�'r3d3 - -
)OAG.ZD
Ce�(REV6"B' APPLICA ION FOR PERMIT
mr ,
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
SEE SEE
FOR APPLICANT TO RLL IN DISTIIICT NO GIUDQ rAv v Essen aY
BK rG
BUIlDINO /� /� ��// 1•
AOONEBa UjJ
NNECTION DATA
LOCALITY
CNEARESTROSSS STATION ' DEPTH
'
cRosa sT
YANHOL{RKPaRINCH
owgew !'U�WV Lown
MAIL �� TYPE OF CONNECTION LENGTH FROM
ADDRESS Y CURB PL METOPE
�[ SPC N0
, 1 ,1
CT' OO T L NO / CO IMF NO 3� �i JOB NO
LEGAL TRUNKPl RMRNO ROAGPERMITNO
DESCRIPTgN LOTNO
V AFFIDAVIT WANES EASEYENI RSConD INSTR NO DAT{
al TRACT `
NO OFBLDOS
EQE Or LOT •Q NOWONL T HWY CRST WIDENING
UBC OP
BURDIHOS STATE NCROACHMSNT
PERMIT
PCRYR NO
CONTRACTOR INDUSTRIAL
WAST!APPROVAL
ADDRESS CHARGEE
CTT, TCL NO S'- / CONNECTION CHARGE FEE
Is
uul�NS-No fV- 7 cuss OR Ems q
NO DESCRIPTION OF WORK FEEAPPROVALS DATE INSPECTOR 3 SIGNATURE
HOUSE SEWER CONNECTING TO
PUBLN:SEWER
SEPTIC TANK SEEPAGE PIT OR
RNEW HOUSE SEWER
PE AND/OR DRAINFISLD CONNECT ADDITIONAL
H W SH EE WSR CONNSCTWG TO BUILDING OR WORK
PRNATE D15POSAL SYSTEM
COIINIECT ADDITIONAL BLDG OR SCPTICTANK SEEP PRISI
WORKTOHOUSHSEWER AND/ORDMINFlELD
O"RFLOWSHSPAGBPR DMINFIHLD CESSPOOL ❑ DRY WELL❑
E%TN CESSPOOL DRYWS MANHOLS
ALTER REPAIR OR ABANDON HOUSE ALTER REPAU, SAWCR OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND -
I ASANDON HOUSE SEWER
RACEPILLSEPTIC TANKS 0
OWNER'S
Permit `S SEEP PRIs10 CESSPOOLS 01
AUTHORIZATION I TOTAL FEE VALIDATION -
I HAVE AT THIS DATE A CONTRACT WITH THE TRACTOR TO CONNIE TH¢ABOVE DESCRIBED ■REIN NAMED CON ;26979A
TO THE PUBLIC S!
SIGNEDTHIS DAY OF f� '" �# S [ [ [
OWN{R O
OWNERS
2 • • 4000
ADDRESS
I H¢ BY ACKNOWLE S THAT I HAVE RlAO THI6 APPELLATION .. * 040005
AND ST H IAT TH[ V! 13 CORRECT AND AGRC6 TO COMPLY
WITH WNTY OR INANCS{ AND STATE LAWS REGULATING 1 ^ Q rl rl TS
PLUMB AHDag WERS - - I lA G / 1
I HE BY CKRTVY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REWIREDLOS WII
Alq EL66 CTY AND STATE OF 1
CALYORNIAOR TNATIAY ELEOAL OWNER Or AND INT[NDTO R!
SIDE IN THE ABOVE OR ED RlIIID[MIAL PRO►lS TY
SGNATURE - I • _ _ - -
OPPCRMRTH6 _