HomeMy Public PortalAbout10112 LANDSEER ST_Sewer__ _8,
76A6423-61
APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O {�
JOHN A, LAM /
BIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building_ LOCALITY i
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL O OWNER /
DESCRIPTION LOT N0.
MAIL -2v
BLOCK TRACT ADDRESS ft7 /T
SIZE OF LOT NOW ON OTS / CITY 6-7-x TEL. N Z
USE OF
BUILDINGS DISTRICT N0. GROUP YAP PR ED BY
`/( 1 BK P8
CONTRACTOR
ADDRESS ) X6 2o� COANECTIOX DATA .
CITY' / TEL.N0. ?a-Z STATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. `e- B COUNTY t LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO i1
PUBLIC SEWER @ $3.00 Cl`' TYPE OF CONNECTILENGTH FROM }O
SEPTIC TANK,SEEPAGE PIT OR Y. CURB 7p--L J M.L.TO P.L. `J
PITS AND/OR DRAINFIELD S3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD a
EXTN..CESSPOOL,
ESSPOOL DRYWELL @ S2.00
HOUSE SEWER CONNECTING TO P.C.N0. �' �- O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. -�D✓iif� V� U
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. w
WORK TO HOUSE SEWER $1.00
ALTER,REPAIR O R ASYSTEN HOUSE @ $1.00 STATE ENCROACHMENT
SEWERPERMIT NO. U
INDUSTRIAL CL
d
WASTE APPROVAL N
CHARGES z
OWNER'S PERPHIT g .2 00 CONNECTION CHARGE FEE
AUTHOREZATION TOTAL FEE REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEEIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIST NG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLICS ER.
SIGNED THIS_ DAY OF L)4,y" 19 6 L NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT n 47 ' 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 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE14
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT M THE'LEGAL R OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED OR L P PERTY. SEEP.PITS ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
ALMATION ROBERT A.,WOOD
Cs
U.0. CASH SUPERVISING MECHANICAL ENGINEER
U ,71 6 4 m ,SAN17 1 0 0 5.0 0 �