HomeMy Public PortalAbout9567 PENTLAND ST_Sewer__ DEPAK.TMENT OF COU-N-TY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
J. FOX, COUNTY ENGINEER ADDRESS I
FOR APPLICANT TOMFILI,,�IN LOCALITY
BUILDING / / NEAREST
ADDRESS (n e<.�t� ` � _ CROSS ST. 3
LOCALITY DISTRICT NO. I SERIAL NO. PERMIT NO. c
NEAREST `--� ,
! A S
CROSS ST. L RECEIVED BY I Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY I MAP
BK PG
CITY TEL.NO. j
CONTRACTOR
CO.IMP.N0.
ADDRESS JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
�j STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
-DESCRIPTION LOT NO. PERMIT NO. _
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO – REIMBURSEMENT FEE
PUBLIC SEWER Q $ 3.50 RECEIPT NO. DATE i BY
—1I HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- i DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER i
_ 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
41 E_ Ust+- LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE ----
I 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
SIGNED THIS...._..............DAY OF....----.............._._____..._.19..._-.. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........:.:. ........._....._:...--------------_.._.....-. --------_ BUILDING OR WORK
/r r' a SEPTIC TANK,SEEP.PIT(S)
ADDRESS...............................................................------..... - AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 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 _
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND
ARID/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
USE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[:] CESSPOOLS❑
SIGNATURE
OFPERMITTEE - ..._ - --......._.........._......- — -•----
76A642A 663 7/53