HomeMy Public PortalAbout9572 PENTLAND ST_Sewer__ ➢IEPAUTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER
ADDRESSFOR APPLICANT TO FILL IN LOCALITY
BUILDING - NEAREST
ADDRESS CROSS ST. _
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST--- _ A _ S
CROSS ST. —i
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USEZ^NE OCCUPANCY MAP
B!( PG
CITY TELAO.
CONTRACTOR
-- CO.IMP.NO. ....,
ADDRESS )OB NO.
CITY TEL_N0. TRUNK PERMIT NO.
STATE
REGISTRATION NO. �f COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. _PERMIT H0.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
i
NOW ON LOT CHARGES
USE OF
BUILDINGS COW-.- CTION CHARGE FEE
------------
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE,_
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
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 ` DATE BY
SE_W ER 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 J STATION t ? DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE WER
TYPE OF CONNECTION -LENGTH FROM
__ Y. CURB P.L. �M.L.TO
OWNERS PERMIT $ 1 00 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 — -
i
SIGNED THIS_..................DAY OF...._............._.....................19...... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........................._.........._..---......_._...-..-.-•-...-..__.._ BUILDING OR WORK (i
SEPTIC TANK.SEEP.PIT(S)
ADDRESS. - -......-..................................- ....._..... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E) DRYWELL I]
CA
TICN AND STATE THAT THE ABOVE 1S CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING,AND SEWERS. SEWAGE DISPOSAL SYSTEM I—
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED NIr
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDISCODNECT D
PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ON HOUSE PLUG
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE �
OFPERMITTEE....... - ..........-.................----
76A642A 663 7/53