HomeMy Public PortalAbout5634 SULTANA AVE_Sewer__ YUFaa0 •.-, APPLICATION FOR PERMIT S7 5
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COUNTY of LOS ANGERS APPLICATION
DIS AL
DEFASTM NT OF COUNTY EiGINIM -
BUMDDiG AND SAFETY DSVMON BUILDING -
JOMF A. T AMM Cn®7 >mpm•w ADDRESS
CAMTr A GRI7M, Sop'1 of Bump iouun
FOR AP ANT To IN NEMEBT
NEAR ST
LEGAL
DESCRIPTION RO OWHIM
BLOC[ iMCi MAIL
ADDRESS
F BLOT
SIZE OF LOT NNO ON LOT C TEL NO '
USE OF
BUILDINGS DISTRICT NO OROUf YAP PROCESSED BY
CONTRACTOR /
ADDRass CONNECIION DATA
C TEL NO yye 3 STATION DEPT
REGISTRATION N1 000 CO TE O UPP
NO 117IDESCRIPTI N OF WORK FE[
Pla
UlL CSEEEWEERCONNECTING TO S O a
BET RK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM /
PITS DOR DRAT NFIELD $S 00 T CURB P L M L TO P L
OVERFLOW SEEPAGE PII77�DMINFFIELD
EXTN CESSPOOL DRTN'ELL MANHOLE 2 00
HOUSE SEWER CONNECTING TO P C NO.
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO 303 NO
CONNECT OUSE flA BLDG OR TRUNK PERMIT NO ROAD PERMIT AO
CORNEpTT ADDIT SEW 100
BENEER OR DISPOSAL BAND HOU I / // STATE ENCROACHMENT
JTST00 40 V PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHANGES
OWNWS pEBMT5 2 00 CONNECTION CHARGE FIX
AUTHORIZATION FTOTAL FEB REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAVED CAN APPHOVAIS DATE INSPECTOR 481GAATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EEISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS OF Jg_ NEW HOUSE SEWER '
OWNER OR C� / CONLD N6 ADDITIONAL:
WORKA
OWNERS AGENT
AD MD
SOT C TAN
OR DMI FIE LDK SEEP,fRTil
N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CESSPOOL DRYWE
WITH ALL COUNTY ORDINANCES MD STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I MEREST CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEVER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL 8E CTANKSSO0
SIGNATURE
OF PERRI
/yAUDAIION ROBERT WOOD
GLV ■ 0 Dud SHIP111Fi1NSIHOI uMCHMCAL MNG NZISR
' ' 6 9 4 4 - k'OV 3 1 O A 6.0 Q n"
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APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTbUM OF COUNTY MGM=
BUB.DING AND SAFETY DIVISION BUILDING
ADDAlBS
TOIDI 11. LRMM Comll omffb�Q
CAOMM D GRUTM.SW1 of Dulld1mg Louutt
NEAREST
FOR APPLICANT TO F= IN DRo99 9T
LEGAL pcnz
OWNER
DESCRIPTION LOT NO -
[AIL
BLOC[ TRACE ILAILkDDRE33 old 2
NO 0 GS
SIZE OF LOT NON LOT CI TEL NO
USE .1 DISTRICT NO GROUPYAP PGOCESSED BY
BUILDINGS /PQ
CONTRACTOR
ADDRESS h CONNECTION DASA
CITYTIL XO f'fe�TH STAT70N
PER
REGISTRATION NOF COUNTY YANHO [ L
NO DESCRIPTION WOR FEE O
HOUSE
-PUBLIC
OUHOUSESEWER CONNECTING TO [S 00
SEPTIC SSAEXNAEky�EPApQ P{2 O8 Y 'TYPE OF CCUHB`TION P L Y LLEN0T0 P L Y Q
PITS AND/OR DMINFIELDa #300
OVERFLOW SEEPAGE PIT DRAINFIEE
EITN CESSPOOL DRYWELL MANHOLE [00
HOUSE SEWER CONNECTING TO P C N0.
PRIVATE DISPOSAL SYSTEM 100 CO IVP NO JOB NO
WORK C XOUSE SXAL BLDG OR I TRUNK PERMIT YO ROAD PERMIT NO
ALTER REPAIR OREAARARNDON HOUBI STATE ENCROACHMENT
SEWER OR❑ISPOSA SYSTEM 1 CO PERDIT HO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEMOS �
CONNECTION CHARGE FEE
AU HORMnON I TOTAL FEE o D REIMBURSEMENT FE
I HAVE A7 THIS DATE A CONTRACT WITH THE HEREIN NAMED CON AMOVAlS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED ¢ISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS DAY OF-19 NEW xoT
OWNER OR CONNECT A ADDDITIOITTO
NAL
OWNERS AGENT BUILD]N6 OR WORK
3 cSEEP
IKL PIT(S)
ADDRESi
AND OR
DRAT DMIMFI[LD
1 HEREBY ACKNOWLEDGE THAT 1 HAYS READ THIS APPLICATION
AND STATE WITH ALL Crl
OUNTY ORDINANCES ORDINANCES LORRECT AND AGREE AND STATE LAWS REGULATING CESSPOOL DRTNELL
ALTERREPAIR [EWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A■ THE LEGAL OWNER OF Till ABOVE BACKFILL 9 C TANKS❑
DESCRIBED GEBIDE L PHOPEEtt. SEEP IT 9 CESSPOOLS
SIGNATURE
OF PER
ALMATION ROBE WOOD
[i [.B. CYE fL7pMRV111tl0 BlECNANICAI.B:!lOINEER
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