HomeMy Public PortalAbout9563 PENTLAND ST_Sewer__ DEPARTIAENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FDX, COUNTY ENGINEER ADDRESS z, �,J'- � ,/ , .✓ >', y ' �t
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT N0. e
NEAREST _-— I A `a
CROSS ST.
RECEIVED BY � Ready for inspection � DATE ISSUED
OWNER
MAIL USEZONE OCCUPANCY MAP
ADDRESS I BK PG
CITY TELAO.
_.Y
CONTRACTOR CO.IMP.N0.
ADDRESS 10B NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. - COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO. - —.
BLOCK TRACT i � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS. CHARGES "
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 I— RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO 1
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. f DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
_UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. _—CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE d
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER --- —
i I
SIGNED THIS.................._DAY OF.................................. 19_.__._. NEW HOUSE SEWER ->
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT....-�t BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-------------- ------......•----..........- - --------_---_-.._... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED R DISCONNECT PLUG AND
AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
USE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej
SEEP.PIT(S)C] CESSPOOLS L}
SIGNATURE
OFPERMITTEE.--------•----------------------- - - _....-------
76A642A 663 7/53