HomeMy Public PortalAbout5631 SULTANA AVE_Sewer__ O .
CESpSS'DI APPLICATION FOR PERMIT
CE8OS 3
COUNTY OF LOS ANGE.Ei SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY D1VIWON BUILDING
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REST
FOR "M FILL IN c SS m
LEGAL
DESCRIPTION LOTHO MER
BLOCK TRACT VRAIL
'VI/ ADDRED!
NO OF Dim"
BAIL
SIZE OF LAT NOR R LOT C
USE OF
BUILDING DISTRICT NO I GROUP I YAP m
CONTRALTO Q K
ADDRESS VVV CONNECTION DATA
CITY TEL NO S s STATION, DERV
TE
REGISTRATION NO COUNTY MANHOLE REFERENCE UPPER
No I DLSCRIPTPF IVURA FIE
NOUSECS&ECRCONMECTING TO S
SEPTIC TAANK SEEPAGE PITO! 00 TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD T CURB P L Y L TO P L
OYERFLCE S�`*DRl INFIELD S,,OO }
O
NO SE SEWER CONMECTI O TO P C NO O
„E D/IIpp 7 0 CO IMF NO JOB ND 1.1
WORK TO N EIONIIL BLDG ORZ 0 1300 kTRUNK�RHITYIT NO WAD PERMIT NO A R PAIR OR ASANDDISPOSALSYSTON HOUSE OACXYLNTO
100 LROVA CMAR Z
OwNws PEMT N CHARGE FEESAUMOB=TION TOTAL FEE MENT FEE
iRwAcioa rpTMco°x°Hec�r iHe"Eve anTMcal m HEREIN Tn�Aoe Luna APPROVAL$ DATE INSPECTOR D SIGNATURE
TO THE PUBLIC SEVER.
SIGNED THIS vAY pP 9_ NEW ECUDE SEWER
/ i I
OWNER OR �' CONNECT ADDITIONAL
OWNERSAGENT DUI(DING OR WORK a
ADD SEPTIC TANK SEEP Pt (S)
V
AND/Olt DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t NAME READ THIS APPLICATION I _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEVERN SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPS REGISTERED AMD/OR TE OF DISCONNECT PLUG AND
CALIFORNILICENSED A ORE TUIR I BY LTHIL OS AMLGEE dN[e OF THE UK" AND AAMOVE AMID/OR
HOUSE SEWER
DESCRIBED REBIDE AL PW BACKFI LL DE CTAM RS
SIGNATURE DEEP PITS CESS
OF PERYI
AIMATION ROBERT A WOOD
B 0. CASE SUPERVISING MECHANICAL XNG:NUM
Ulf' 3 1 6 0 Qf MAY 2 8 1 0 p 5.0 O ta
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r
7GA"R -61
D APPLICATION FOR PERMIT
CE1108
COUNTY OF LOS ANGELES SEWER—SEWAGE DISIML
DEPABTb= OF COUNTY ENGINEES
BUD.DDYG AND SAFETY DIVIMON ADI LDINa
O�H�I�QyA. LRMBR�l, p,,, � g p„,� ADORES$ .3/
""__' A• JPNIE!! -n__d.RQ_ LOCALITY
nEAREer
FOR Di CROSS BY
LEGAL
DESCRIPTION LOTMO vE. OWN®
BLOCK TRACT I111 (//Fp (,{� ADIL DR[d3 C—,,, C vJ
s>a OF LOT now ON LLAOTG' 3 C 3
US[OF
BUILDINGS !�' 4' DISTRICT NO 1 GROUPYAP BY
�. B[ FO
CONTRACTOR – —/&�l
ADDRESS CONNECTION DATA
cnT / TEL NO _/ '1'J / STATIO1 DEPTH
REGISTRATION NO STATECOUN7T YANNO EFEREYC6 R
NO I
a DESCRIPTION
F[[
PRO 9EV CONNECTING TO 00
SEPTIC TI�NK aaEEPAGE PIT OR T TYPE OF CURB OIIP L TO PFROY
PITB AND/OR DMINFI[lD
OVERFLOW SEEPAGE PI DRLI,AINFIELD G
PRIMA
SEE EDI
Vspo"i It
EEpR CCOpNIt
NN�LR 070Do CO INP NO JOBMO O
WORK TO ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERP 0 O
A NU11]E 6EABANOON NOOSE OO dD STATE KNCROA SENT
9. PERMIT HO
INDUSTRIA O.
W STE APPROVALN
CHARGES ?
O�S PEBDUT y 00 CONNECTION CHARGE FEE
AUTHOffiZATION TOTAL PEE REIMBURSEMENT FEE
I HAVE AT N NAMED 009-
TRACTOR TO CIONNECT THE ABOVE DESS DATE A CONTRACT 7CRIBED H THE S)STINO DWELLING AMOV DATE INSPECTOR$SIGNATURE
TO THE PUBLIC RKWER.
SIGNED THIS DAY OF +B_ NEN HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDS PEPTIC TANK SEEP PIT(D)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ORTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR n
PLUMBING AND SEWERS SEWAGE DISPOSAL STST6
I HEREBY CERTIFY THAT I AN PROPIRLT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER � I
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE AGO Y[
DElCflIBED RESID PRO BACKFILL SE C TANKS
SIGNATURE SEEP PIT($) C POO /
OF PERMIT
ROB T W
m VALIDAiiO� YUPEIiV1Y1N ti4
U'L-)2812 % MAY 181 0 D 500 2 �_�