HomeMy Public PortalAbout10124 LANDSEER ST_Sewer__ -6,
76A6423-61
APPLICATION FOR PERMIT
78A 642
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
BU
ILDING
JOHN A, LAMBIE. County Enqq��neer ADDRESS // wQ
WILLIAM A. 1ENSEN. Supt of Building LOCALITY Fs L%ry
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. c
LEGAL OWNER
DESCRIPTION LOT NO.
BLOCK TRACT 2 , °2� MAIL
A DRESS 67
NO.OF BDGS. /
SIZE OF LOT NOW ON LOT CITY C TEL. NO
USE OF WaLum
BUILDINGS DISTRICT NO. GROUP MAP PROCfS BY
/ BK PG.
CONTRACTOR _ �1 D
ADDRESS p , ^^ ✓ CONNECTICA D TA
CITY TEL.NO. �q �`'l STATION DEPTH
eSTATE MANHOLE REFERENCE
REGISTRATION NO. l3 �— COUNTY
NO. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $9.00 v TYPE OF CONNECTIO LENGTH FROM
SEPTIC SEPAE
PITS AND/OR TANK,
OR @ $3.00 Y. CURB P.L. M TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL.DRYWELL @ 52.00 a
HOUSE SEWER CONNECTING TO P.C.NO. .0 / Q
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. ;�- �J V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ 51.00 O
SEWER OR DISPOR OSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT r
PERMIT N0.
INDUSTRIAL Y.1
WASTE APPROVAL
to
CHARGES Z
ovmFrS PERICT S 2100 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE ,S REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DAT€ INSPECTgR'S SIGNATU E
TO THE PUBLIC SEWER (//
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER , ll�ffr6
OWNER OR CONNECT CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
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 SYSTEIJ
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIAOR THAT I THE LEGAL OWNER F THE ABOVE
DESCRIBED RESIDENTI PR PERTY. BACKFILL SEPTIC TANKS -
SIGNATURE SEEP.PITS ❑ CESSPOOLS
OF PERMIT
AMATION ROBERT A. WOOD
cr M.o. CASH SUPERVISING MECHANICAL ENGINEER