HomeMy Public PortalAbout10130 LANDSEER ST_Sewer__ -61
7CEBOB
6A6423-61
APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT-OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. L 4
LEGAL
DESCRIPTION LOT N0. / OWNER 1
BLOCK TRACT 26,SZZ MAIL
ADDRESS �� /hs✓!�l YY tV
JfO.OF BLDGS.
SIZE OF LOT NOW ON LOT C1 07Y TEL. NO T O L
USE OF
BUILDINGS DISTRICT NO.IT
MAP PROCESSED BY
BK PO CONTRACTOR �4.1 O,. �. �� Ll1
ADDRESS X �� CONNECTION DATA
CITY, t N / TEL.NO. Q-2 y STATION DEPTH
�? STATE MANHOLE REFERENCE UPpE
REGISTRATION NO. J L �� -- w�_ H COUNTY ��
NO. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTIO LENGTH FROM `�
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L M.L.TO P.L. -'�
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00 a
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. U
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ 31.00 TRUNK PERMIT N0. ROAD PERMIT N0. CK
SEWER OR DISPOS L SYSTEM HOUSE a $1 00 STATE ENCROACHMENT O
PERMIT NO. U
INDUSTRIAL W
a
WASTE APPROVAL to
CHARGES Z
OWNERS PERMIT $ ,2 00 CONNECTION CHARGE FEE
AUTHORIZATION FTOTAL FEE s cc) REIMBURSEMENT FEE
1 HAVE AT THIS DATE A.CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIED EXISTING DWELLING APPROV= DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE (J/
SIGNED THISDAY OR /�YJ 19� NEW HOUSE SEWER
OWNER OR � CONNECT ADDITIONALd
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
_ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I' HAVE -READ THIS APPLICATION
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS_ REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR `THAT I A E LEGAL OWNER _ THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTIAL PE Y.
SIGNATURE SEEP.PIT(S ❑ CESSPOOLS
OF PERMITTE
�Ay ATION ROBERT A. WOOD
cK M.0. CASA SUPERVISING MECHANICAL ENGINEER
1p�; 7 1 s 6'Q! JAN 17 1 o p 5.0.0