HomeMy Public PortalAbout9321 PENTLAND ST_Sewer__ DIEPARTnmNT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY 'PERMIT APPLICATION
COUNTY OF LOS ANOELE$
WILLIAM J FOX, COUNTY ENGINEER— BUILDING [%-
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FOR APPLLIC T TO FILL IN I LOCALITY G�
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LDING NEAREST
CROSS ST
ALITY DISTRICT NO SERIAL NO PERMIT NO
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IVE /L USE ZONE OCCUPANCY BK NAP PG
ADDRESS 1
CITYtotTEL.NO (� I K�5 / 7
CONTRACTOR CO IMP NO Z
ADORERS JOB NO
CITY f� 0 TRUNK PERMIT NO
REGISTRATION M 1 e COUNTYt
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 1 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT NO � 9 �Q ! INDUSTRIAL -
WASTEAPPROVAL
SIZE OF LOT 6p x ibo' NOW ON LOTS .:2_ I CHARGES
USE OF- ' `,
BUILDINGS }- CONNECTION CHARGE EE
NO DESCRIPTION OF IC FEE REIMBURSEMENT FEE -
HOUSE SEWER CONNECTING 0
PUBLICSEWER ! $ 350 �/ RECEIPT NO DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR _ EXCEPTION fl ORDED
WORK TO HOUSE SEWER 100 NO DATE BY
ALTER OR REPAIR EXISTING 1..
SEWER OR DISPOSAL SYSTEM 1 DO Y
D ISCONNECT AND ABANDON SEWER CONNECTION DATA
AND/OR DISPOSAL SYSTEM 100
SEPTIC TANK SEEPAGE PIT OR _
PITS AND/OR GRAINFIELD - 200 STATION 7 DEPTH
CESSPOOL—DRYWELL1} '
SPECIAL CONDITIONS ONLY 200 ; 17. Z '�MANNPPE EFERENCE LOWER
_` TYPE OF CTION LENGTH FROM -7-
f7
OWNERS PERMIT $-1 "1 '—ODS CURB -cm M L TO P L 6
AUTHORIZATION TOTAL,FEE
1 HAVE_THIS DATE CONTRACTED WITH THE HEREIN NANED6
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
'7 NEW HOUSE SEWER,
SIGNED THIS r7.� DAY OF _ _ _19.� /i
OWNER OR CONNECT ADDITIONAL / nn
OWNERS AGENT BUILDING OR WORK y� d•- O/b�1C✓
qq / SEPTIC TANK SEEP PIT(S)
ADDRESS ;?,3 1 AMD/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE REA IIS I- CESSPOOL DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORREC AMD AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATI NB PLUMBING AND SEWER SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESI�AL PROPER BACKFILLS❑PTIC TANK
SEEP PIT(S) CESSPOOLS
SIGNATURE
OF PERMITTEE - - -
76A642A 663 7/53 t