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Click ‘Get Form’ to open the permit of lacitysan application in the editor.
Begin with Section 1, FILING STATUS. Check the appropriate box indicating whether this is a new point of discharge, an existing un-permitted point, or a change in ownership. If applicable, provide the previous company name and permit number.
Move to Section 2, COMPANY INFORMATION. Fill in your City of Los Angeles Business Tax Registration Certificate number and legal business name. Select your ownership type from the options provided and list business officers along with their titles.
In Section 3, DENTAL OFFICE OR CLINIC DESCRIPTION, describe your business type and operations. Include details such as the date operations began, number of employees, hours of operation, and estimated flow to sewer.
Finally, complete Section 4 by certifying that all information is accurate. Sign and date the form as an authorized representative.
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