HomeMy Public PortalAbout5625 SULTANA AVE_Sewer__ DPIPASTDffiVT OF CDIINxs ENanve¢x SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUELDING AND SAFETY PERMIT APPLICATION
COUNW OF LOS ANGISM
WILLIAM J. FOX. COUNTY ENGINEER BUD'LWOW 1
ADDRE88 JrG�S—ZS Ste. aria
APPLICAANT TQ.RLLc LOCALITY
DBS � NEAREST
/ USST
n=S Or-
LOCALITY DISTRICT NO SERIAL
QMO� �T PERMIT YO�A�
NEAREST S I8C�'4 1 19slo-Os
CROSS ST
� RECEIVED BY Rudf(w IOTP(atloe DAT8188UED
OWNE!!!ti�vy
MAILUSEZONB OCCUPANCY BK MAP
ADDRESS pa
CITY TELMO. - 1
CONTRACTOR
CO-IMP N0.
ADDRESS G� ,y/ L -go, S r JOILno � _
CITY L TELNO .4 D 4P!f b G TRUNK PERMIT NO
STATE
REGISTRATION NO44 COUNTY
ROAD PERMIT NO
LEGAL rr �r STATE ENCROACHMENT
DESCRIPTION LOT NO _ r ���� PERMIT NO
DUSTIAL
BLOCK TRACT d/i Al A, 'Y/r, WASTE APPROVAL
SIZE OF LOT c;y'X 16 _l NOW ON LOT CHARGES
USE
OF L CONNECTION OE FEE
BUILDINGS
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONE6 IY TO
PUBLICSEWER O 11 SBO RECEIPT NO DAT BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT A 1 1 N OL OR PTION RECORDBD
WORK TO HOUSE SEWER 1 00 2oo O
ALTER OR REPAIR EXISTING DATfi BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 0o CONNECTION DATA
SEPTIC TAMK.B EPAG I OR
PITS AMD OR DRAT NFIELD 040 STATION TN
CESSP00 RYWELL
SPECIAL CONDITIONS ONLY 200UPPER CE LOWER
OF CONNECTION LENGTH FRO
OWNERS PERMIT f a DD RB P L M L TO P L
AUTHORIZATION I TOTAL FEE `z` a
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR '
-BUILDING OR WORKADDITION AL
a�
OWNERS AGENTIGG7« SEPTIC TANI48EEP.PIT(8)
ADDRESS _ AND/OR DRAINFIELD
CATIONANDSTATE THAT THE ABOVE 8 CORRECT AND AGREE CESSPOOL DITYWELL
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
AND/OR LICENSED IAS REQUIRETHAT I D BY PROPERLYB NGE ES REGISTERED
DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY C M(
SIGNATURE 11""'T1
SEEP PIT(8)o CESSPOOLS0
OF PERMITTEE
TBAam 000 7/53