HomeMy Public PortalAbout9034 PENTLAND ST_Sewer__ J8$08.0
DEoe-a-ee APPLICATION OR PERMI
COUNTY OF LOS ANGELES1
SEWER—SEW SPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING t
ADDRESS
JOHN A. LAMBIE. Ceuuty B.ginSSr
CASSATT D. GRDFIN. Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TOFIU IN cxoSS ST. �t e-
LEGAL
DESCRIPTION LOT NO. L LL OWNER J3 I
MAIL
BLOCK TRACT ADDRESS C Y'
NO.OF SLOGS. '
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT N0. GROUP MAP CESSED BY
BK P
CONTRACTOR r-
ADDRESS C. CTI N
CI , v, L.NO Qa: 7 7STATION A DEPT
MANHOLE REFERENCE UPPER
REGISTRATION ATE UNTT �
NO. DESCRIPTION OF WORK FEE `
HOUSE SEWER TO
IC ERS3.00 ®L)
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTIO LENG
PITS AND/OR DRAINFIELD a S3.00 Y. CURB M.L.
OVERFLOW SEEPAGE PIT, DRAIN FIELD
EXTN.,CESS POO L.DRYWE LL.MA N H OLE @ $2.00
HOUSE SEWER CONNECTING TO L P.C.N0.
PRIVATE DISPOSAL SYSTEM $1.00 CO.IVP.N0. JOB NO,
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT
WORK TO HOUSE SEWER a 1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSP URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE R. �/�, , !7
SIGNED THI AY OF 1L1U NEW HOUSE SEWER
OWNER OR r I 1 CONNECT ADDITIONAL 1
OWNERSAG .r'- BUILDING OR WORK
ADDRESS i J AND/OR DRAISEPTIC NFEELDPIT(S)
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESWENITIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE ` - SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITT9F
®r VALIDATION ROBERTA.WOOD
OK. 9.0. cux 1 SUPERVISING MECHANICAL ENGI
l ;; ; 91 4 F JAN 1n i G D 5.00