HomeMy Public PortalAbout9008 PENTLAND ST_Sewer__ °A°42° APPLICATION FOR PERMIT 1t17
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ND
eec DIVISION OF BUILDING ASAMMY SEWER—SEWAGE DISPOSAL 1
Dep. ant of County Engineer
County of Los Angeles BUI LD IN DRESS /(
JOHN A LAMBIE COUNTY ENGINEER ADDRESS (J
® CABSATT O GRIFFIN SUP T of BUILDING LOCALITY -
FOR APPLICANT TO FILL IN moss sT ;
�+� LEGAL _
,l�'DESCRIPTION LOT NO�?e RV.61 OWNER' 2
s n NAIL
BLOCK TRACT 7i
MAIL
��110 OF BLDGS CITY ENO :]
SIZE OF LOT 3 '7 NOW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP r K NAP P
CONTRACTOR CALIF SEWER CO
=ION DATA
1317 COLEG ROVE AVE. coN
ADDRESS .
CITY MONTEBELLGEL NO PA 1-5048 STATION DEPTH 04
180767&�p -ATE C1 STATE MANHOLE REFERENCE UPPER
REGISTRATION NO l=� ❑ COUNTY
No DESCRIPTION OF WORK FEE '
TYPE OF CONNECTION LENGTH FROM +J q
HOUSE SEWER CONNECTING TO B O1 Y CURB L M L TO P L
PUBLIC SEWER Q 3 3
' SEPTIC TANK SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD ® $3 00SEEPAGE PIT q
EXTNFLOW CESSPOOL ORYWELLRELD MANHI '
OLE ® $2 00 CO INP NO �[Q.lZL� JOB NOO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q S 100 TRUNK PERMIT NO ROAD PERMIT NO '
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (a $ 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ S 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE ( _
OWNER'S PERMIT S 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRI 0 Ex1 T NG DWELLI G
TO THE PUBLIC S R NEW HOUSE SEWER _
SIGNED THIS AY OF CONNECT AD OITIONAL
OWNER OR BUILUIN OR WORK
OWNERS AGENT SEPTIC TANK SEEP PIT(S)
ADDRESS- 4 AHD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE TH,•T THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL S NTY AND STATE OF (DISC DON HO PLUGAUSE D '
CALIFORNIA OR THAT 1 A E LEG ER OF HE ABOVE
DESCRIBED RESIDENTIAL PE �J BACKFILL
SIGNATURE / CESSPOOLS CJ -
OF PERMITTEE
JOHN A LAMBIE COUNTY E)'rGV ALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
(`cx M 0 CASH -
L%05838 '� APR 28 1 0 A
5.0 0