HomeMy Public PortalAbout9584 PENTLAND ST_Sewer__ ]DEPAlVfMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES �
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
LOCALITY
BUILDING FORAPPLI'CAtAT T04-%L IN NEAREST
ADDRESS
-------.--
CROSS ST.
LOCALITY _ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST �C-�. Y.r ;
RECEIVED BY i Ready for Inspection DATE ISSUED
y
OWNER_
MAIL --T�— -- —----
ADDRESS USEZONE OCCUPANCY ivtA31
BK PG
CITY TEL.NO. �.
CONTRACTOR � °1 '`
-
ADDRESS t✓• /3j JOS NO.
,�-
TEL.NO. TRUNK PERMIT NO. - -- t
$TATE
REGISTRATION NO. I� COUNTY ROAD PERMIT NO.
LEGAL J
DESCRIPTION LOT N0. STATE ENCROACHMENT ---- -
/ PERMIT NO.
BLOCK TRACT INDUSTRIAL -•---�-----
WASTE.APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE OF
BUILDINGS ° ,i i.,, CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 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 _
ALTER OR REPAIR EXISTING NO- 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 y '"t i DEPTH
CESSPOOL—DRYWELL —
SPECIAL CONDITIONS ONLY 2.00 fa f ff� MA..',iiVic REFERENCE
UPPER / er` L.C':'F.,
_ TYPE OF CONNECTION LENGTH FROM
CURB P.L. M.L.TO P.L.
OWNERS PERMIT � _ 1 , 00_ -- -
AUTHORIZATION TOTAL FEE I y __ --
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIC NATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_.-,-_...........DAY OF....................._-,...--...__._...19...-... NEW HOUSE SEWER I �
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.-...---..y- BUILDING OR WORK
t - - .-.... -.._...-- 4�
ADDRESS-------------------....:..........__..._... SEPTIC TANK,SEEP.PIT(S)
----------------_---•�----•-••-----------... AND/OR D RA f N F I E LD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] 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 I 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 PRO ERTY. BACKFILL SEPTIC TANKS
rf SEEP.PIT(S)[] CESSPOOLS[]
SIGNATURE
OF PERMITTEE//-3' (/1 ... 7" .. ..-.. N--
6A642A 663 7/53
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