HomeMy Public PortalAbout10125 LANDSEER ST_Sewer__ -61
76A6423-61
APPLICATION FOR PERMIT
76A 842
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUII.DING AND SAFETY DMSION B
MBBUILDING, /
JOHN A, LAIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building_ LOCALITY QL 7Y
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. LJC//%�'C���A�✓
LEGAL
OWNER ( / /,t✓�E
DESCRIPTION LOT N0. 71
BLOCK TRACT MAIL
ADDRESS OG T C tA0
140.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY A7(4C 6-fV TEL: NO T 41
USE OF
BUILDINGS DISTRICT N0.j GROUP MAP PROCESSED BY
f BK PG
CONTRACTOR _
ADDRESS /� CONNECTIONDATA
CITY• TEL.NO. fia 3(}—Z 7 STATION DEPTH
STATE MANHOLE REFERENCE PER
REGISTRATION N0. �'—
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $8.00 TYPE OF CONNECT LENGTH FROM
SEPTIC DgNK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD S9 00
OVERFLOW SEEPAGE PIT.DRAINFIELD }
EXTN..CESSPOOL,
ESSPOOL DRYWELL @ $2.00 CL
HOUSE SEWER CONNECTING TO P.C.NO. -�� O
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO. dG1iMG,- �� V
CONNECT ADDITIONAL,BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. d'
WORK TO HOUSE SEWER $1,00
ALTER OR PAIRO R A SYSTEN HOUSE @ $1.00 STATE ENCROACHMENT O
PERMIT NO. u
INDUSTRIAL ti
WASTE APPROVAL V)
CHARGES ?
OWNgS PERMIT s00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
t HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED.CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAIS DATE, INSPECTOR'S SIGNOTORE
TO THE PUBLIC SEWEVI ' P
SIGNED THIS DAY F ✓ 19 NEW HOUSE SEWER
OWNER OR tl,, CONNECT ADDITIONAL OF
OWNERS AGENT (/w 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 ❑ DRY-WELL
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 M THE LEGAL OWN OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTI PR ERTY. SEEP.PLLSIT(S ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
AIMATION ROBERT A. WOOD
CK. Y.0. CASH SUPERVISING MECHANICAL JMGINEER
tl 7 1 5 6 tg JAN 17 5.0 0