HomeMy Public PortalAbout9239 PENTLAND ST_Sewer__ E 6eo
8& APPLICATION FOR PERMIT 1
BDMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
DeposI out of County Englnser
County of Los Angeles BUILDING 1-30
JOHN A LAMBIE COUNTY ENGINEER ADDRESS /V
® CASSATT O GRIFFIN Sup TOP BUILpIND LOCALITY L. t
EAREST
FOR APPLICANT TO FILj OSS ST 9ZIV F ia/T7P.
LEGAL NER 1`
DESCRIPTION LOT NO 7 ���UZ �
BLOCK TRACT ' 2 Z I URESS]
NO OF BLDGS '.� (��� TEL NO
SIZE OF LOT Q NOW ON LOT
USE OF w� ISTRICT NO - GROUP YAP
BUILDIN G9IR w BK PG
CONTRACT O A/ 1 f'_ NJtb • dCONNECSION DATATION �� DEPTHCI TEL NONXOLE REFERENCEs0UPPE ERREGISTRATION NO / �j. 2 NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
UBLIC SEWER @ $3 CURB PLM L TOPLSEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3OVERFLOW SEEPAGE PIT DRAINFIELO P C NOQEXTN CESSPOOL DRYWELL MANHOLE ® $2 IMP NO JOB NO D
HOUSE SEWER CONNECTING TO - 7
PRIVATE DISPOSAL SYSTEM B 51 00 TRUNK PERMIT NO ROAD PERMIT NO
CO N NECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q s 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE S OAl 1 Z-11-
OWNER'S PERNUT s I 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEES—
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS DATE INSPECTOR 5 LGI TORE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE ER NEW HOUSE SEWER
SIGNED THIS DA(Y OF / Mk_19s� CONNECT ADDITIONAL
OWNER OR /. l', �/ BUILDING OR WORK t
OWNERS AGENT i_e4 •�a� SEPTIC TANK SEEP PIT(S)
ADDRESS / AND/OR DRAINFIELD i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW
ER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
Iz
DESCRIBED RESIDENTIAL PRO ERTY �� BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(5) ❑ CESSPOOLS 7
OF PERMITTEE t
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK No CASH
I AC05 0 5 4—� DE01 2 4 4.50
>ee APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engmew
County of Los Angelos BUILDIRG
WM J FOX, COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST '
CROSS ST
LEGAL
DESCRIPTION LOT NO ^ OWNER
BLOCK TRACT /OC� 0 MAIL ADDRESS A
L
SIZE OF LOT NONOWOF ONBLOUGS
T CITY F TEL HO U-7.3.0
USE OF
BUILDINGS DISTRICT NO GROUP MAP
CONTRACTOR BK PG
ADDRESS CONNECTION DATA
CITY TEL NO STATION DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO ❑ COUNTY LOWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER ® 5 3 50 Y CURB P L M L TOP L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG OR P C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEA 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRA INF(ELD 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
PERMIT COlF GGiIYII CIr'_.vEE i
OvMER'$ S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
HAVE ITRACTORTTOSDATE CONNE TOTHEACTED WITH THE HERIN ABOVE DESCRIBED E%ESTINGA DWELLINMED G APPROVALS DATE INSPECTOR S SIGNATUREt
TO ThE PUBLIC SEWER
SIGNED THI-RDAY OF 79—
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
(SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ ORYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOI,E ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIG
SEEP PTI')
T 5 CESSPOOLS❑
N
OF ATURE PERMITTEE `A A�w `r
WILLIAM J FOX, COUNTY ENGINEER VALIDA'T'ION R A WOOD CHIEF PLBG INSPECTOR
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