HomeMy Public PortalAbout9578 PENTLAND ST_Sewer__ DEPAWTMENT OF COUNTY ENGLNEER SEWER-SEWAGE DISPOSAL 7
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER DDRE
AS
ADDRESS
FOR APPLI NT 30 FILL IN LOCALITY
BUILDNEAREST
--ADDRESS ly� r� CROSS ST. y
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A 5
CROSS S'T, --
/ _ RECEIVED BY Ready for Inspection DATE iSGUED
OWNER
MAIL — USE ZONE j OCCUPANCY I MAP
ADDRESS I OK PG
CITY TELAO.
CONTRACTOR 1� .. fb,e_ .._•�-' c (- GO:f,iF.NO.
ADDRESS + r I JOB NO.
CITY
/ TRUNK PERMIT NO.
// STATE
REGISTRATION NO. / COUNTY ROAD PERMIT N0.
LEGAL _ �—
DESCRIPTION LOT NO. STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT ` ' INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT � CHARGES
USE OF
BUILDINGS Ii J _ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE i13Y
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDR.OR EXCEPTION RECORDED
__WORK TO HOUSE SEWER 1.00
NO
ALTER OR REPAIR EXISTING I DATE I 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 2.00v" MANHOLE REFERENCE
r5, ,_''N' _ UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 _00_ V.1- LUP$ 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
DWELL!NG TO THE PUBLIC SEWER - -
SIGNED THIS--------------------DAY OR_.....................-.............19-_._-.- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT--- .............•.--._.........._........................._._•---•--•_- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----•-------•---_-----------------------_-------__------ AND/OR D R A I N F I E L D
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECTAND AGREE -�
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I DISCONNECT PLUG AND
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
USE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PR PERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) CESSPOOLS
SIGNATURE i' i -� �;��_ CLL O ❑
OF PERMITTEE!.._ -•_<_.S ........-.- -- ._..�...... -
76A642A 663 7/53 77A `/ f f sl „ _,.