HomeMy Public PortalAbout9331 PENTLAND ST_Sewer__ TEMPLE COTY
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ClIaGa a FP APPLICATION FOR PERMIT 1
eeoe COUNTY OF LOS ANGELESi
DEPARTMENT OF COUNTY ENGlNM SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION ADDRESS C. /
JOHN A LAMIE Count En .r
CASBATT D GSIFFM Suet of Budd=, LOCALITY
NEAREST
FOR APPLICANT TO FILL. IN -Ross sr
LEGAL / � 7 OWN
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DESCRIPTION LOT NO T aG rER 1/G/LJ
BLOCK TRACT �pZ a � MAIL
ADDRESS
OF BL
SIZE OF LOT ON LOT
CITY TEL NO
USE OF DISTRICT HD GROUP YAP PROCESSED BY
BUILDINGS C Y PG
CONTRACTOR
ADDRESS CONNECTION DATA
CI TEL NO STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO COUNTY LOWER
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® $3 00 TYPE OF CONNECTIQ.NI
LENG FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB L M O P L
PITS AND/OR DRAINFIELDIT SS 00
OVERFLOW SEEPAGE IT
DRAINFIELD
EKTH CESSPOOL DRYWELL@ 5200
HOUSE SEWER CONNECTING TO P NO
PRIVATE DISPOSAL SYSTEM
SI 00 CO IMP NO JOB
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PER T NO
WORK TO HOUSE SEWER S 0 '
A1ILA-RGPA+R ABANDON HOUSE I _ STATE ENCROACHME
0 OS LSy SI00 ( PERMIT NO
INDUSTRIAL
WASTE APPROVA
CHARGES
OWNERS PERMITS Z CONNECTION CHARGE FEE
AUTHORMATION ' TOTAL FEE 00 REIMBURSEMENT FEE
I HAVE T THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR A TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWE
SIGNED THIS. K DAY_OF NEW HOOSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN / BUILDING OR WORK
ADDRESSS SEPTIC
TANK
SEEP IELD PIT(S)
AND/ORI HEREBY ACK WLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 1 40
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWEALTER REPAIR SEW ER OR
R9
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSESD
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOYE
DESCRIBED RESIDENVAL PROPERTY BACKFILLSEPTIC TANKS ❑
SIGNATURE . SEEP PIT S CESSPOOLS
OF PERMITTE
®F VALIDATION ROBERT A WOOD
/�!y Y o Wtl SUPERVISING MECHANICAL ENGINEER
Lfr,7 5 2 6 f3At 2 A 1 0 D 3 00 �8