HomeMy Public PortalAbout10121 LANDSEER ST_Sewer__ -6,
76A6423-61
APPLICATION FOR PERMIT. - -
76A 642
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING fI/
JOHN A, LAMBIE, County En neer ADDRESS (J
WILLIAM A, IENSEN, Supt of Building_ LOCALITY Ty
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ? OWNER 2
DESCRIPTION LOT N0. v
BLOCK TRACT 2 MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY byX 7Y TEL. NO T
USE OF
__.BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY
BK P8
CONTRACTOR CCU 01
ADDRESS v / CONNECTIOlf DAT
CITY TEL.NO. 37
3Q STATION DEPTH'
REGISTRATION N0.
G ._�� STAT TY MANHOLE REFERENCE _UPPER
NO. DESCRIPTION OF _ FEE
HOUSE SEWER CONNECTING TO /
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION,--'-,, LENGTH FROM fJ
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. L/
PITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL DRYWELL @ $2.00 _ d
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. -404-40,
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER $1.00 O
SEWER OR DISPOSALABANDON SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL I7.1
WASTE APPROVAL
N
CHARGES a_
OWNERS PERMIT 3 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE S OU REIMBURSEMENT FEE
i HAVE AT THIS.DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATq INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE e^ /
SIGNED THIS a DAY OF}— (1A�_ 19 NEW HOUSE SEWER
OWNER OR /V CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,'SEEP.PITS)
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 ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTE
I HEREBY 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 f THE LEGAL OWNER F THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTI PR P RTY.
SIGNATURE SEEP.PIT S CESSPOOLS
OF PERMITTE
�AI IDATION ROBERT A:WOOD
Cs
1111.0. CASH SUPERVISING MECHANICAL]ENGINEER
U;o? 1 5, 7 JAN 17 1 O D 5.0 0 �;