HomeMy Public PortalAbout10105 LANDSEER ST_Sewer__ -81
76A6423-61
APPLICATION FOR PERMIT
76A 642
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS G. A�
WILLIAM A. JENSEN, Supt of Building LOCALITY P4e (�/7Y
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. �!
LEGAL
DESCRIPTION LOT NO. OWNERMAIL
---
BLOCK TRACT ADDRESS T �Ll,ILJ
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY L 7 TEL. NO Z
USE OF
BUILDINGS ` �� DISTRICT N0. GROUP MAP PROCESSED BY
ry BK PG
CONTRACTOR 0 'c
/U{
ADDRESS QF MIN DATA
CITY TEL.NO. J—Zy STATION .�� DEPTH
STATE REGISTRATION NO, B COUNTY MANHOLE REFERENCE�� (/ UPP
ATE
t (f
NO. DESCRIPTION OF _ FEE
HOUSE SEWER CONNECTING TO U
PUBLIC SEWER @ $8.00 TYPE OF CONNECTIO LENGTH FROM
Q
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD a
EXTN..CESSPOOL.DRYWELL @ S2.00
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, VOB.N*. i U
CONNECT ADDITIONABLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. d'
WORK TO HOUSE SEW& $1.00
SEWER R DASRO R A SYSTEN HOUSE @ St OO STATE ENCROACHMENT 0
PERMIT NO. C1
INDUSTRIAL uJ
d
WASTE APPROVAL H
CHARGES ?
OWNER'S PM-UT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE q a.) REIMBURSEMENT FEE
i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBE EXISTING DWELLING APPROVAIS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE
SIGNED THIS DAY'Of— 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT vsuv BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE14
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT A THE LEG L WN R OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTI PR RTY. SE IT
CESSPOOLS
SIGNATURE
OF PERMITTE
ALMATION ROBERT A.'WOOD
CIL Y.0. WH SUPERVISING MECHANICAL HNOINEER
LP,o7 1 6 0 JAN 17 l o p 5.0 0