HomeMy Public PortalAbout9027 PENTLAND ST_Sewer__ 96APPLICATION FOR PERMIT 1
aa660DIVISION OF BUILDING AND SAFETY SEWER-SEWA E DISP SAL
Dep. out of County Englneer
County of Los Angeles BUILDIN Oa -
JOHN A LAMBIE COUNTY ENGINEER ADORE59
® CASSATT O GRIFFIN SUP T OF BuILDINo LOCALITY
FOR APPLIS FRI IN CROS55T
LEGAL OWNE
DESCRIPTION LOT NO a
BLOCK TRACT ADI U
N BLDGS
SIZE OF LOT N LOT TEL
USE OF
BUILDINGS DIS CT NO bROUP YAP
-45 PG
CONTRACTOR f �
ADCONNECTION DATA
DRESS
¢.
� STATION Z7�DEPTH
CI Y tyYL N -MANHOLE REFERENCE ALARrR
/jy
REGISTRATION NO / Y/ d (/ p- ❑ COUNTY
No DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM /
HOUSE SEWER CONNECTING TO Y CURB P L M L TOP L
PUBLIC SEWER @ f 3
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® S 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD d♦�T P C NO
EYTN CESSPOOL DRYWELL MANHOLE f 2 00 CO IMP NO L♦ POB XO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® f 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM S 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT o
REIMBURSEMENT FEEa
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSI GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER � � �y NEW HOUSE SEWER
SIGNED THIS DA F 79+i(_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS A T SEPTIC TANK SEEP PIT(S)
ADDRES AHD/OR DRAINFIELD
I HEI
E E Y AC NOW E E THAT 1 HAVE READ THI APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
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 OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF TME ABOVE
DESCRIBED RESIDENSIAL.PROP RTY n�'' BACKFILL SEPTIC TANKS CI
SIGNATURE "�9 .'1 //yh�J SEEP PIT(S) CICSF 6,B POO L61l
OF PEPNITTEE ••' JJJ,,,�"", Y v
JOHN A LAMBIE COUNTY ENGINEER /'yALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
IvN J Y 0 [AeX
LAUD,5 7 6 7 E�; Aar, 2 7 1 0 A 5.0 0 n
J0A84APPLICATION- FOR PERMIT 1
:
e a E e6D VISION OF BUUMING AND SAFETY SEWER-SEWAGE DISPOSAL
DepoTtmsnt of Co=ty Engineer
County of Lee Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS
T CASSATT D GRIFFIN CU'T OF BUILDING - LOCALITY
FOR APPLICANT TO FILL IN NEAREST
79
]
CROSS STT
LEGAL . /
DESCRIPTION LOT NO A / ry, OWNER �j _lam/�( • , �(_,/_�( __
BLOCK TRACT S ,5 '�� x - I ✓ MAIL FFFII7
ADDRESS
SIZE OF LOT GxJO O NOCF W ON LOTS
CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MATPG BK
CONTRACTOR 1�
ADDRESS CONNEC710N DATA
CITYlygjde�Z14EL NO /-N,�4 --;L S TION DEPTH
y`9 IR STATE MANHOLEREFERENCE
REGISTRATION NO ❑ COUNTY UPPER LOWER
TY P F CONNECTION LENGTH FRQe
NO DESCRIPTION OF WORK FEE Y RB P L M L TO P
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® $ 3 30 _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IUP NO JOB NO
WORK TO HOUSE SEWER 1 00 _
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMEN
/
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYW EIL WASTE APPRO L
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CON�! IT]ON CHARGE FEE
OWNER'S MI
1 00
AUTHORIZATION TOTAL FEE EI MBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON I
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER
GT ti} r i
SIGNED THIS DAY OF 19— NEW HOUSE SEWER l
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT BUILDING-OR.WORK
ADDPESS - SEPTIC TANK, SEE TIS
1 HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
D
ANSTATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES
S AHD STATE LAWS REGULATING
ALTER REPAIR SEW M
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
C
I HEREBY CERTIFY THAT I AN PROPCRLYCOUNTY RA RE0 ANO/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELESWNERAND STATE OF ABANDON HOUSE SEWER
CALIFORNIA SI THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRO4ERTT BACKFILL SEPTIC TAXKS❑
SEEP PIT 9 CESSPOOLS
SIGNATURE
OF PERMITTEE "
WILLIAM J FOX COUNTY ENGINEER VALIDATION
_ ?}� 7'2 5AM 18 4 4.00
.BY
DEPUTY T DEPUTY
,BY BY
. ® DEPUTY DEPUTY