HomeMy Public PortalAbout9002 PENTLAND ST_Sewer__ ;e E•;;,1;, APPLICATION FOR PERMIT 1
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dapoxtment of County Engineer
County of Los Angeles euaDlxG Dd .�
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATTD GRIFFIN SUP T OF BUILDING LOCALITYI
FOR APPLICANT TO FILL IN caoss si
LEGAL
DESCRIPTION LOT NO OWNER
MAI
BLOCK TRACT �`,S_4 ��2_�+S �r4f9$3 ADDRESS
sl NO OF BLDGS CITY TEL NO
SIZE OF LOT �j ')✓NOW ON LOT
USE OF DISTRICT NO GROUP
BUILDINGS BK MAPPQg,
CONTRACTORCALIF SEWER CONST CO ..,
ADDRESS - 1317 COLEGROVE AVE. 1A00 O ONECT3 DATA
CITY MONTEBELL{`EL No PA 1-5048 STATION DEPTH
UPPER
180767 STATE ❑ STATE MANHOLE REFERENCE LOWER
REGISTRATION NO C y Ay ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO -1 Y CURB L M L TO P L Q
PUBLIC SEWER C� 5 3 V
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD (g $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD - P NO 'R
EKTN CESSPOOL DRYWELL mSvpw eE ® 5 2 00 CO IMP NO y lOBC HO a'y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q S 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM IN $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 00
AUTHORIZATION
D d REIMBURSEMENT FEE
TorAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS _ DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWERNEW HOUSE SEWER
SIGNED THIS 1 DAY OF��// 194 CONNECT ADDITIONAL
OWNER OR c .a. I< - BUILDING OR WORK
OWNERS AGENT ,, J/W SEPTIC TANK SEEP, PIT(S)'
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[I ORYW ELL❑
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR pISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELE CO TY AND ATE OF ABANDON HOUSE SEWER
CALIFORNIA R THAT I A LEGA 0 R OF T ABOVE _
DESCRIBED RESIDENTIAL PERT KFI LL kPF16 TMNk�f]
SIGNATURE
9J� CESSPOOLS - 0-
OF PERMITTEE I - ,
JOHN A LAMBIE COUNTY E G /VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR 1
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