HomeMy Public PortalAbout10115 LANDSEER ST_Sewer__ 1
-6,
76A6423-61
APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS F
WILLIAM IL JENSEN, Supt of Building LOCALITY !7Y
NEAREST
FOR APPLICANT TO FILL. IN CROss sr. �f
LEGAL
DESCRIPTION LOT NO. OWNER /
BLOCK TACT MAIL
ADDRESS �C / e— T 1
SIZE OF LOT NOW ON OTS CITY FL C./y TEL. NO —1
USE OF
BUILDINGS DISTRICT N0. GR MAP PROCESSED BY
0 BK Pa
CONTRACTOR � �� ��-"
ADDRESS Q CONNECTIO DATA
CITY �y TEL.N0. ��-2 gL STATION (/ DEPTH
/ STCO.
LE REFERENCE
REGISTRATION NO. 1 B CV _ LOWER
N0. DESCRIPTION OF FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $5.00PE OF CONNECTIO LENGTH FROM /
PETS ANPTIC D/ORDRAENFGEL IT OR @ $5.00 CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL.DRYWELL @ S2.00 d
HOUSE SEWER CONNECTING TO P.C.NO. -� O
PRIVATE DISPOSAL SYSTEM @ $1.00 . NO. -AFB. � /� I V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. w
WORK TO HOUSE SEWER 51.00
SEWER OR DISPOSAL ABANDON
YSTEM HOUSE @ $1.00 STATE ENCROACHMENT O
PERMIT NO. ,V
INDUSTRIAL a
WASTE APPROVAL N
CHARGES ?
OWNERS PERM $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
TRTHIS
ONNECT THE ABOVE ES RIBED EXISTINGADWELLING MED CON- APPROVALS
ACTOR TO CDATE INSPECTOR'S SIGNATUkE
TO THE PUBLIC S e
SIGNED THISDAYOF ��� 19 NEW HOUSE SEWER 1I (L c'- �'� ✓''"�0/
OWNER OR �„/ CONNECT ADDITIONAL
OWNERS AGENT , BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I 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 AIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT THE LEGAL OWNE OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTI PR RTY. BACKFIL S ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
ALIDATION ROBERT A. WOOD
Cc
U.0. CASH SUPERVISING MECHANICAL ENGINEER
a 7 1 5 81c'D" JAN 17 1 0 p 5.0 0 'LID r