HomeMy Public PortalAbout9583 PENTLAND ST_Sewer__ DEPA2tT31ENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENINEER BUILDING
G
ADDRESS
LOCALITY
FOR APPLICAN T� FILL IN., _ --
BUILDING �^ r- 3 NEAREST
ADDRESS j !1 •-� ( _ CROSS ST.
LOCALITY Ter yY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST a r I A
CROSS ST. -ull
gal
RECEWED BY i Ready for Inspection I DATE ISSUED
MAIL
ADDRESS BIC USE ZONE i OCCUPANCY M'.'P
PG
CITY TEL.NO. I
J �
CONTRACTOR T1 -C-1.4wx.ND.
ADDRESS
y 0! -.3 /` s JOB NO.
CITY �I r;O TELAO.l�"? !DL
S�� TRUNK PERMIT N0.
REGISTRATION NO. // �� 3 � �COUNTY ROAD PERMIT N0.
LEGAL cq STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
SOW ON LOT CHARGES
USE OF
BUILDINGS L. CONNECTION CHARGE FEE
No.' DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
i HOUSE SEWER CONNECTING TO
1 PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO. I DATE I BY
ALTER OR REPAIR EXISTING
_SEWER OR DISPOSAL SYSTEM 1.00 I _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEP IC-�—TANK,SEEPAGE PIT OR f —
_ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL —SPE IAL CONDITIONS ONLY 2.00 I MANN OLE DEFERENCE
U'PP'ER
_-_I_-_-- TYPE OF CONNECTION LENGTH FROM
O`' N"ERS PERMIT 00 I Uti� P_L. M.L.TO P.L.
AUT HORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS fNSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF......._..........._.................19._.__.. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT............ ..__
.1 SEPTIC TANK.SEEP.PIT(S)
ADDRESS--................ --•------------•--•-----•-----------------------••-----•--•------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL F DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TG 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
AHD/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
SEEP.PIT(S)[] CESSPOOLS(]
SIGNATURE
OF PERMITTEE .-��leC!d._LL�� r' ° --.---
76A642A 663 7/53 f�1