HomeMy Public PortalAbout9533 PENTLAND ST_Sewer__ 6&E 6 12" APPLICATION ,FOR PERMIT 1
6DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of Comly EDgmcec
a County OE LOS Angalec DRESILDINSG �—
WM J FOX COUNTY ENGINEER AlA
CASSATT D'GRIFFIN Epp T op BUILDING LOCALITY
FOR APPLICANT TO FELL IN NEAREST
CROSS ST
LEGA L
DESCRIPTION LOT NO -7 J
OWNER �/AN/ai CL
BLOCK TRACT Z PAIL /J�
ADORES$ y
NO OF BLOCS
SIZE OF LOT NOW ON LOT CITY r TEL NO
USE OF ��//A A'
BUILDINGS DISTRICT NO GROUP YAP
T r;
CONTRACTOR B(f�/ �,. 3
4 9 /
ADDRESS CONNECTION DATA
CITY Oval& - TEL NO A6W a � STATION DEPTH
� ❑ STATE MANHOLE REFERENCE
REGISTRATION NO ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
No DESCRIPTION OF WORK FEE Y CURB P L
HOUSE SEWER CONNECTING TO 1 3Z
_ PUBLIC SEWER 0 $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM - 1 00
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 1 00 odo CO INP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 OO INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
- CONNECTION CHARGE FEE
OWNER'S PERMIT E 1 00
AUTHORIZATION TOTAL FEE �J ; p REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNECT THE:AABOVECTED WDESCRIBED EX ITH THE 9TfNGA DWELL NG CON APPROVALS DATE INSPECTOR 5 SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF NEW HOUSE SEWER A6� 16LT4 C-AGV= WID L C O
SI19
OWNER OR CONNECT ADDITIONALp
OWNERS AGENT BUILDING OR WORK L Al �G.pe
SEPTIC TANK SEEP PIT(S)
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PEATY BACKFILL SEPTIC TANKS❑
.. SEEP PIT 9 ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE _
WILLIAM J FOX CouNTY ENGINEER VALIDATION
By LACpoY37ON- XT16 4 2.00 '0
DEPUTY i DEPUTY
h _
.`BY BY
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DEPUTY lX �PUTY