HomeMy Public PortalAbout9020 PENTLAND ST_Sewer__ TeaeASP
cseoa a ea APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES I SEWER—SEWAGE •DISPOSAL _
DEPARTMENTINE9 -
OF COUNTY ENGEt
BUILDING AND SAFETY DIVISION BUILDING
JOHN )L LABEE, Coo Engineer ADDRESS
Mm
CAS13ATT D GE97IN SUP t of BUildm LDCALITT ^
NEAREST
FOR APPLICANT TO FILL IN CRoss ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
3 ADDRESS
• NO OF BLDGS , t
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO I GROUP BK MAP PROCESSED BY
l
CONTRACTOR CALIF SEWER CONST CO
ADDRESS 1317 C O LE G R CONNECTION Pf.�N ATA
CITY MoNTFRFII qEL NO `A 1-504 I STATION 2 Re DEPTH
STATE MANHOLE REFERENCE / UPPER
REGISTRATION NO COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO a
PUBLIC SEWER S 00
SEPTIC T1�HK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD ® $3 00 Y CURB P L' N L TOP L
OVERFLOW SEEPAGE PIT DRAINFIELD
EITN CESSPOOL DRYWELL MANHOLE 2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 1 CO-IMP NO P NO
CONNECT ADDITIONAL BLDG OR • TRUNK PERMIT NO ROAD PERMIT NO
WORK To HOUSE SEWER $1 DO
ALTER REPAIR OR ABANDON HOUSE S� A.R
ENCROACHMENT
SEWER OR DISPOSAL SYSTEN 1 00 IT NO
STRIAL
E APPROVAL
CHARGES
OWNER'S EMIT S 2 00 ECTION CHARGE FEE
AUTHORIZATION TOTAL FEE URSEMENT FEE -
1 HAVE AT 7X15 DATE A CONTRACT WITH THE HEREIN NAMED CONAPPROVALS` DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THI OF _ I HOUSE SEWEROWNER OR ECT ADDITIONALOWNERS AGENT ING OR WORK[TANK SEEP PIT(S)R DRAINFIELDIHEREBY ACKNOW THAT 1 HAVE READ TRIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLT OOL DRYWELL CIWITH ALL COUNTT ORDINANCES AND STATE LAWS REGULATING REPAIR SEWER ORPLUMBING AND SEWERS GE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RED RE @Y OS NGE 9 C NTY AN STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AX T ER OF HE•ABOVE
DESCRIBED RESIDENT PROP _ BACKFILL
SIGNATURE `CESSPOOLS O-
OF PERMIT TEV17
®. ATION ROBERTA-WOOD_
c¢ ■ o - c H SUPERVISING MECHANICAL ENGINEER
-I LA(,O518 3 •6 u; APR.28 1 u A - 5.0 0 "�9,-
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