HomeMy Public PortalAbout9327 PENTLAND ST_Sewer__ TEMPLE CITY
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C980a a as APPLICATION FOR PERMIT 1
lceoe COUNTY OF LOS ANGELES +
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMMING AND SAFETY DIVISION BUILDING
ADDRESS
OHN A LATaIE County Enp�nwr
C TT D GRIFFIN 9vp t e! Bwld�vq LOCALITY
NEAREST
FOR APPLICANT TO FILi IN CROSS ST
LEGAL
DESCRIPTION LOT NO C OWNER
BLOCK TRACT MAIL
ADDRESS
0 OF BLDGS
SIZE OF LOT C/rte NOW ON LOT CITY TEl NO
USE OF
BUILDINGS G DISTRICT NO GROUP MAP PROCESSED BY
CONTRACTOR > '� Y PG
ADDRE44 CONNECTION DATA
CITY TEL NO STATION DEPTH
STATE MANHOLE REFERENCE - UPPER
REGISTRATION NO COUNTY LOWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Cm $3 00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L H L TOP L
PITS AND/OR DRAINFIELD 300
OVERFLOW SEEPAGE PIT DRAINFIELD
EKTN CESSPOOL DRYWELL $200
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SY EM St 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER $102--
ABANDON
1 00 '
.m ISP..�^A ANDDON HOUSE 100 �Q STATE ENCROACH M ENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT E 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT MED CON
Co
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING S DATE A CONTRACT WITH THE HEREIN ADWELLIING APPROVALS DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEW�py/
SIGNED THIS�DAY OF �� — 79 NEW xousE 9Ewea
OWNER OR // CONNECT ADDITIONAL
OW HERS AGENT BUILDING OR WORK p
ADDRESS l/�J/1-�� SEPTIC TANK SEEP PIT(S)
® �'
AN 0/OR'DRAINFIELD J�
1 HEREBY AC OWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL Ej
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLT 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 RESID AL PR BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP IT
9 CE49P00 L5
OF PERMITTE
or Y /'VAI,ID0{q'IOIQ ROBERT A WOOD
CAI
�C ■ v tl SUPERVISING MECHANICAL ENGINEER
Lf,��7 5 2 5 RAY 2 4 1 ;a D 300 N _
TEMPLE CITY
T6AS4SR
csaos a so APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
RUILDDNG AND SAFETY DWISION ADDRESS
AUILDIN
JOHN A LAMBIE CowtT Enp�v��r
CASSAIT D C;RUFR7 Supt 01 B.1" LOCALITY
NEAREST
FOR APPLICANT TO FIU IN CROSS sT —
LEGAL
DESCRIPTION LOT HO S INNER
14
BLOCK TRACT MAIL
ADDRESS
BLDGS
SIZE OF LOT ON LOT CITY TEL NO
USE OF
BUILDINGS e DISTRICT NO I GROUP I MAP PROOFS D BY
PG
CONTRACTOR ((((((JJ
ADDRESS S•GTO CONNECTION DATA
CITY TEL NO 7 STATION DEPTH ✓'
STATE MANHOLE REFERENCE
REGISTRATION NO _ COUNTY I
NO DESCRI ION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 TYPE OF ION LENGTH FRO
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TOP L
PITS AND/OR DRAINFIELD S3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
NO
HOUSE SEWER CONNECTING TO P C 0
PRIVATE DISPOSALSYSTEM $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER 1 00 '
ALTER OREPAIROO ABANDON HOUSE @ SI 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES L
OWNERS PERMIT S 4 2 00 CONNECTION CHARGE FEE / /
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE IJ
IHAVEMED CON- AA
TRACTORA TO CIONNECT THE ABOVE DESCRIBED EXIISTINGDATE A CONTRACT WITH THE HEREINADWELLIING APPROVALS DATE INSPECJOR S SIGNATURE
TO THE PUBLICS A n
SIGNED HI A F 1 NEW HOUSE SEWER %�7 ��P�o•.0
OWNER OR CONNECT ADDITIONAL
OWNER9 AGENT 4' BUILDING OR WORK
AODRES 0 /!/ SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AON
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO TO COMPLY CESSPOOL DRYW ELL
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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CA LI FORNI R T T 1 AN THE EGA ER OF TN ABOrE ABANDON HOUSE SEWER
DESCRI AL PROPERT BACKFILLSEP C TANKS ❑
SIGNATURE SEEP PITS CESSPOOLS
OF PERMITTE
®rLIDATION ROBERT A WOOD
Ca Y O CUtl SUPERVISING MECHANICAL ENGINEER
L&2 5 3 9b SEP 2 1 0 0 5 .0 0 M