HomeMy Public PortalAbout9579 PENTLAND ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, BUILDING
COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY `.
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY T '^ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
BI( PG
CITY TEL.NO.
CONTRACTOR CO.IMP.NO. _
ADDRESS !OB NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. A d COUNTY ROAD PERMIT N0. -- �
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACTI � 4 �8 r. INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT ". NO.OF BLDGS.
NOW ON LOT CHARGES
USEOF
BUILDINGS ,•� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
— PUBLIC SEW ER @ $ 3.50 RECEIPT N0. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00 —
ALTER OR REPAIR EXISTING NO DATE I BY
SEWER OR DISPOSAL SYSTEM [.GO_ _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 _ CONNECTION DATA _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00
STATION -} f DEPTH
CESSPOOL—DRYWELL r --
SPECIAL CONDITIONS ONLY 2.00q/ MANHOLE P.EFERENCE
�V C; J UPPER
YPE OF CONNECTION ,,LENGTH FROZ1
OWNERS PERMIT $ !r 0 Y. CURB P.L. e/ M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIEED EXI
STING _APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING l'0 THE PUBLIC SEWER
SIGNED THIS------_---.------DAY OF.......___.._....._...._.._......19....---- NEW HOUSE SEWER
OWNER OR / CONNECT ADDITIONAL j
OWNERS AGENT j- f .._...1r=_.. .._.........__.._. BUILDING OR WORK l
w SEPTIC TANK,SEEP.PIT(S)
ADDRESS—--------------------y--9 - -......- -......................................... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E
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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- —
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El
SIGNATURE SEEP.PIT(S)[:] CESSPOOLS E]
OF PERMITTEE. --- — - - _............. ------.-....- --
i 6A642A 663 7/53