HomeMy Public PortalAbout9470 PENTLAND ST_Sewer__ r �ry
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APPLICATION ORPERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BuI LDING
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WILI.IlINI A ]ENBEN =up 1 01 Biu 7 ILOCALITY 4
157/
NEAREST
FOR APPLICANT TO FILL IN CROSS ST I ,
LEGAL
DESCRIPTION. LOT NO OWNER SG
BLOCK _ TRACT MAIL ^
ADDRESEn 7e,-
NO OF BLDGS 3
SIZE OF L07 NOW ON LOT CI N f�
USE OF
BUILDINGS DISTRICT NO LGROUP I
BR YAP CESSED BY
PD
CONTRACTOR Q__0 O � Z
ADDRESS CONNECTION DASA
CITY TEL NO STATION DEPTH
REGISTRATION NOV COUNT' MANHOLE REFERENC UPPER
LOWER
No I DESCRIPTION OF INUM - FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 9 $S 00 TYPE OF CONNECTION LENGTH FROM
SEPTIC T)1MK SEEPAGEPIT OR Y CURB P L Y L TOP L
PITS AND/OR DRAINFIELD S!00
OVERFLOW SEEPAGE PIT DRAINFIELD
r
EK CESSPOOL DRYWELL !Z 00 1
HOUSE SEWER CO NNECTING TO C NO 0
-PRIVATE DI P SAL SYSTEM 5100 CO IMP NO U
CONNECT ADDITIONAL BLD6 OR OC
WORK TO HOUSE SEWER SIO TRUNK PERMIT NO ROAD PER
A TER RE PAIR OR ABANDON HOUSE !I W !TATE ENCROACHMENT Q
t PERMIT NO �W
INDUSTRIAL D_
WASTE APPROVAL h
��s
�
OWNws PERMIT s 2 00 CONNECTION CHARGE FEE CHARGE! ?
AUMOMATION I TOTAL EEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EAISTING DWELLING AMOVALS DTE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS nAy OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL /
OWNERS AGENT BUILDING OR WORK _
ADDRESS SEPTIC TANK SEEP PIT(!)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL O DRYWELI
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
SYSTEM
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR AND SEWAGE DISPOSAL A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RE TIA1.}R0 - BACK FILL SEPTICTANK9
SIGNATURE SEEP PIT 9 ❑ CESSPOOLS
OF PERNI
VALIDATION ROBERT A WOOD
CA ■ 0 Wtl
SUPERVISING MCC.FUNICAL ENOINMBR
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