HomeMy Public PortalAbout9335 PENTLAND ST_Sewer__ TEMPLE CITY
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ceeoe a as APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
CIM A LAMBIE Co." Enr*%
Tf D GRUTION, up
1 a7 MII(I6Q LOCALITY
XEAREST
11 77ii--
FOR APPLICANT TO FILL IN CROSS ST
LEGAL /
DESCRIPTION LOT NO ; O OWNER
BLOCK TRACT / tlA1L
ADDRESS
F BLDGS
SIZE OF LO ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO BK PG GROUP YAP PROCES ¢BY
CONTRACTOR I
ADDRESS CONNECTION DATA V✓V`�
CI L NO _ a STATION DEPTH
$TATEMANHOLE REFERENCE / PPE
REGISTRAT1 N NO 2 5 A-111-COUNTYG
NO DESCRIPTION OF WORK FEE It
HOUSE SEWER CONNECTING TO
PUBLIC SEWER cm S3 DO TYPE OF yCT10N LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR T CURB P L Y L T P L
PITS AND/OR DRAINFIELD 300
OVERFLOW SEEPAGE PIT DRAINFIELD
E%TN CESSPOOL DRYWELL 3Z 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL
SYSTEM @ Si 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER 100 '
A LT ER O R PAIR SR ABASDOH HOUSE � f100 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
HASTE APPROVAL i
CHARGES //
OWNERS PERMS 2 00 CONNECTION CHARGE FEE 5l'YVI , p
AUTHORIZATION TOTAL FEE `"� REIMBURSEMENT FEE �/ \ j� rlI
I HAVE DATE A CONTRACT WITH THE HEEINAMED C
TRACTOR'TO CIONNECT THE ABOVE DESCRIBED EARSTN G DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEW
SIGNED THI AY O 9 + NEW HOUSE SEWER 9�7
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CA LI FORNI 1 AY TXE GAL 0 R OF THE BOVE
DESCRIBED RESIOENTI L ROPER BACKFILL SEPTIC TANKS
SIGNATURE 1. SEEP PIT 3) ❑ CESSPOOLS
OF PERMITTE I
®F OVALIDATION ROBERT A WOOD ,
Ci ■ Q wtl HUPERVISINO MECHANICAL fiNGINfifiR
L&2 -i 4 4 SEP -12 1 J D 5 .0 0
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