HomeMy Public PortalAbout5625 3/4 SULTANA AVE_Sewer__ - �6aS34
"^eReoe"'° APPLICATION FOR PERMIT' v<r" IA 1
a es
COUNTY of LOS ANGEM SEWER—SEWAGE DISPOSAL
nJMAar>err of covNTT EN�
JfTJD.DII?G AND BAF.FAY D��$(oN 7��
c )��a
JOHN A. LAIum Comm! >�eT
_ CA68H1T D. OYRPHI. Bv't d BuniY
FOR CANT TO NA
LEGAL
DESCRIPTION LOT NO S
BLOCK -4 /3 61
MO OF BLDG!
SIZE OF LOT 1 NOW
ON LOT TEL NO
USE OF
BUILDINGS � YAP PROCESSED BCONTRACTOR � jADDRESS TCONNECTION DATA
CITY Ar TEL NO,4,0 &A
sf(1[7 STATION DEPTH
!TATE UPPER
REGISTRATION NO D COUNTY YAMROIE Raf'BB8NC8
L LOWER
NO DESCRIPTION
ON R
PUBHOULICTS�IENERSCEO�NNECTING TO ! 1
P� 00
�yIITESE AND NREOERAIeeINFyIIBLD T OR FF�� S 00 T TYPE OF CONNECTION P L- LENGTH TO P L Y
E)lTNF CESSPOOLADHYIfRIA.L MANXOL6 $200
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUN6 F8RY1T NO ROAD P T NO
WORK TO HOUSE SEN 1 00
ALTERREPAIR OR ABANDON HOUSE STATE EI/CROACNMENT
!EWER R DISP09 L SYSTEM 100 PERMIT NO
INDUSTRIAL
W APPRO
CHAR
Q�.'� F1BRT 2100 CONNECTION CHANCE F88
AUTHOffiZATION TOTAL FEE RE MBURSE:ENr FEE
SEWER
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN HAYED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER _
SIGNED THIO ^AY OF I B_ NEW ROUSE SEWER
DITTO
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �Yl BUILDING OR WORK
SEPTICTMK SEEP,PITS)
ADDAvS! AND/OR DRAIMPI6LD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 14 CORRECT AND AGREE TO COMPLY CESSPOOL DRTWSLL
WITH ALL COUNTY ORDINANCES AND STATE TAW! REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWER! SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY 660ISTEREO MD/OR DI SCONNER PLUG MD
LICENSED AS REQUIRED BY LOS ANGELES COUNTY MD STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OP THE ABOVE
DESCRIBED BHlIDEN ROPESTT. BACKFILL CTAK
SIGNATURE LEEP PIT 9 C� LS
OF PERYI I ry�
o.'
VAMATI Ro9ERTa WOOD
L . x g6 Uw 9u1YHt18lda nMTHwnCALENGINEER
_�(�7 7 8 3 '; NOV l 9 1 0 A 3_ob