HomeMy Public PortalAbout10106 LANDSEER ST_Sewer__ CE808 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN AA!.AMIE County Engineer
ADDRESS ,
WILLIAM A. JEN3EN, Supt of Building_ LOCALITY F L 6 e.
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. is
LEGAL OWNER
DESCRIPTION LOT N0.
MAIL
BLOCK TACT X522 ADDRESS L G7 L
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 12 CITY 00 TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROU MAP P ED BY
BK PG
CONTACTOR r
ADDRESS CONNECTIO DATA
CITY 7 TEL.N0. 3o-z 4/ STATION DEPTH
REGISTRATION N0. J C 7 �— 7 COUNTY STATE MANHOLE REFERENCE
NO. DESCRIPTION OF _WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $5.00 TYPE OF CONNECTI LENGTH FROM
SEPTIC D)NK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. O
PITS AND/OR DRAINFIELD @ S8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD }
EXTN..CESSPOOL DRYWELL @ $2.00 d
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO. `� V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER $1.00 w
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT Q
EWER OR DISPOSAL SYSTEM@ $1.00 PERMIT NO. G
INDUSTRIAL
WASTE APPROVAL N
CHARGES Z
OWNERS PERMIT 5 2 Q() CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE X D REIMBURSEMENT FEE
CON-
TRACTOR TO CHAVE AT IONNECT THE ABOVE ESCRI ED EXISTING A CONTRACT WITH THE HEREIN ADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SE R. Q� r,� , ' .�. f' ';
SIGNED THIS (
21 I9(p_ NEW HOUSE SEWER
OWNER OR
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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 ALTER,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 BY LOS ANGELES COUN AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR
THAT THE LEGAL OWNE OF THE ABOVE BACKFILL SEPTIC TANKS
DESCRIBED RESIDENTI PR P RTY. SEEP. PIT(S)
S ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
ALIDATION ROBERT A. WOOD
ctL r.o. CASH SUPERVISING MECHANICAL ENGINEER
LACo 7 1 6 3 JAIL 17 1 0 D 5.0 G M