HomeMy Public PortalAbout9329 PENTLAND ST_Sewer__ , TEMPLE EEMPLEE C9 . 4
T"A""'° APPLICATION FOR PERMIT 1
cYAoe °�P, COUNTY OF LOS ANGELES i
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 1142
OHN A LAMBIE Cou t7 E° r
C TT D GEIFTIN Sup t oI =., LOCALITY A
FOR APPLICANT TO FILL IN
CROSS Sr J
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IPTION LOT NO ry/k HER P.
TRACT L MAIL
ADDRESS
NO
OFBLDG9
F LOT NOW ON LOT CITY TEL NO
INGS DISTRICT NO GROUP MAP PR0CE5 BY
/ 9R ?PG
ACTOR 8 4
SS S6 Y� CONNECTION DATA
ION O V O DEPTHTRATION NO OUNTTSTATE MANHOLE REFERENCEDESCRI TI OF WORN FEE 13,.
HOUSE
SEWER CONNECTING TO �p $9 00
TYPE OF CONNECTION LENGTH FROM /1
SEPTIC TANK SEEPAGE PIT OR Y CURB P L Y L TO P L oC..
PITS AND/OR DRAINFIELD S3 00
OVERFLOW SEEPAGEPIT DRAINFIELD
EXTN CESSPOOL DRYWELL 2 00
HOUSE SEWER CONNECTING TO P G NO
PRIVATE DISPOSAL SYSTEM
1 00 CO IMP NO JOB HO
WORK TO HONECT USEISEW ER BLDG OR IB
SI 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER
LT EROEPAI POS ABA ST ON MOUSE $I DO ST ATE ENCROACHMENT
SEWPERMIT NO
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 w�
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SI NATURE,
TO THE PUBLIC SE L�
SIGNE DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ERYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CA LIFO
RNI , THAT I AN THE LEGAL NER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBE RE 9 L PROPE BACKFILL SEPTIC TANKS ❑
SIGNATURE SEW
E PIT 9 C SP00L9
OF PER MITTE
�r ATION ROBERT A WOOD
Y o CAVY SUPERVISING MECHANICAL ENGINEER
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TEMPLE CITY
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C 8 APPLICATION FOR PERMIT
ee°B a :u COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUDADDRESSRESS
oRx A LKMIE County Eu ac
C rr D GRIFFIN Suet of 111 ldm LOCALITY
NEAREST
FOR APPLICANT TO MI IN cgoss sr —
LEGAL
DESCRIPTION LOT NO S/ OWNER
BLOCK TRACTMAIL
ADDRESS
0 OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE DI pp DISTRICT NO GROUP MAP PROCE F,p By
BUILDINGS C �✓ BK PG 1/I`!I
CONTRACTOR �(J A'1 T
ADDRESS �Q'!y ' CONNECTION DATA
CI EL NO _ ION DEPTH ,
STATE MANHOLE REFERENCE PER
REGISTRATION NO COUNTY
No DESCRI TIO OF WORK FEE `
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 DO TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L Y L TO P L
PITS AND/OR DRAINFIELD S3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EA N CESSPOO ORYWELL 52 00
HOUSES EW ER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM Sl 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 0 TRUNK PERMIT NO ROAD PERMIT NO 0
R RE 01 PO L SYSDON HOUSE
49100 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
t�
CHARGES
RrS
OWNEPERMIT ; CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DAA CONTRACT THECON
TRACTORA TO CONNECT THE ABOVE DESCRIBEDEXIISTIING AMED DWELLIING APPROVALS I DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEW
SIGNED NEW HOOSE SEWER
OWNER ' BUNNECT LDINGORDWORKAL . CAI I op
-1
ERS AGENT
ADORES SEPTIC TANK SEEP PIT(S) y
AHD/OR DRAINFIELD // I �l
ANDERESY STATETHAT THE ABOVEDGE IS CORRECT AT I HAVE RAND AGREEEAD THIS TOL COMPLY DHY CESSPOOL LlDRYWELL Z 11 v IPA tv
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR —I
PLUMBING AND SEWERS SEWAGE DISPOSAL ER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE
DISCONNECTDISPOSAL
PLUG SYS
LICENSED EM
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
AND
CALIFORN R THAT I AX THE LE OWNER OF TtW AB
DESCRIS RES IAL PROPE \ BA KFI LL SEPTIC TANKS El
S P PIT(S) CESSP OLS
OF PERMITTE /
i7F VALIDATION ROBERT A WOOD
CL ■ 0 ^••B
SUPERVISING MECHANICAL ENGINEER
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