HomeMy Public PortalAbout9217 PENTLAND ST_Sewer__ DEPAPTAUMVT OF COUNTY ENGINEER f ' SEWER—SEWAGE DISPOSAL
DIVISION-OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER I I Ne
-ADDRESS
DORES$
FOR APPLI T T FILL IN LOCALITY -\C
BUILDING �J NEAREST
ADDRESS iG CROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NO C
NEAREST G � A I�` J
CR0888T L
RECEIVED BY RAady Lr IncyccDm DATE IS UED
OWNER a e �� A -._
MAIL /�, �vG USE 20NE OCCUPANCY BK MAP PB
ADDRESS
CITY TELNO /I IGiT J 5
CONTRACTOR CO IMP NO
ADDRESS JOB MO S A
CITY 7/ s-
474 TEL NO .1/ I TRUNK PERMIT NO
TATE
REGISTRAT N MO COUNTY ROAD PERMIT NO
LEGALPERMIT NO
�� 'S STATE ENCROACHMENT
DESCRIPTION
LOT NO [[ ��JJ
BLOCK TRACT/I, ),/67 ,� N.s��3^ WADURIAL
STE APPROVAL 401"Ao I'i C Aa4I 0-N,4
812E OF LOT NO OF IB
�j
OXUSEOFO/`fin NOW OM LOT �{J CHARGES
BUILDINGS [ Q/yJ/yJ //A//d/ CONNECTION CHARGE FEE �p0 �• S ��
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® { 350 O ft3� 2 I I DATE I BY ���ael-
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTIOq RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DATE BY
8 EWER OR DISPOSAL SYSTEM 100 /
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM IDO CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 [ALTER
TION s I , DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONSONLY 200 72. L MANHOLE REFERENCE
L UPPER
TYPE OF CONNE ION LENGTH FROM O /
OWNERS PERMIT $ I J1 00 '! M L TO P L
AUTHORIZATION TOTAL FEE I ,g
CONTRACTOR TO CONNECT HAVE THIS DATE R THE ABOVE THE HEREIN
EXISTINGAPPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER /� r
SIGNED THIS f�A
AY OF�l��r/ / W HOUSE SEWER $GnYOG>� �L }
i�ly!/IVP INNECT ADDITIONAL
OWNER OR ILDING D WORK
OWNERS AGENT �-- - - -- - - PTIC TANK SEEP PIT(S)
ADDRESSP ,/CG. __ D/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• SSPOOL[] ORYWELL0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HO PLUG AND
AND STATE OF CALIFORNIA OR THAI IAM HE LEGAL OWN-
ER OF THE ABOVE ESCRI BED SI DENT L PROPERTY BACKFILLS PTIC TANK*El
SEEP PIT(S)[] CESSPOOLS[]
SIGNATURE
OF PERMITTE
76A64EA 603 7/53 O