HomeMy Public PortalAbout10131 LANDSEER ST_Sewer__ _61
76A642D APPLICATION FOR PERMIT'
8A642
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building 6'7"Y
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT N0. 77—
BLOCK TRACT � MAIL r�, ADDRESS Q61 T L
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OFMM
BUILDINGS DISTRICT N0. GROU MAP PROCESSED BY
BK PQ
CONTRACTOR / 9 1
ADDRESS 'I CONNECTION DATA
Cl /TEL NO. J -2 STATION , DEPTH
STATE
REGISTRATION NO. C 3 �- COUNTY MANHOLE REFERENCE
/
NO. 1 DESCRIPTION OF WORK FEE C/ O
HOUSE SEWER CONNECTING TO fi
r PUBLIC SEWER @ $8.00 V TYPE OF CONNECTIO LENGTH FROM
SITS AND/OR DRAINFIELD @ S8.00 EPTIC TANK,SEEPAGE PIT OR Y. CURB P.L N.L TO P.L.
P
OVERFLOW SEEPAGE PIT,DRAINFIELD >_EXTN..CESSPOOL.DRYWELL $2.00 a
HOUSE SEWER CONNECTING TO P.C.NO. �` '� 0,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. .J�08=lW, l_ V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMITNO. ROAD PERMIT NO.
WORK TO HOUSE SEWER SLOO lw
SEWER OR DIISPO AA SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT V
PERMIT NO.
INDUSTRIAL d
WASTE APPROVAL H
CHARGES Z
OWN}WS PERM S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATg INSPECTO4'S SIG" URE \
TO THE PUBLIC SEWER,(�y
SIGNED THIS�_DAY F- ( AILS I9 6 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL '
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 IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 0 ••
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
CE
LINSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE 'LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA ERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP.PIT(S) ❑ CESSPOOLS.
OF PERMITTE
ALIDATION ROBERT A. WOOD
Y.o. CASH SUPERVISING MECHANICAL ENGINEER
0
U �'�'.5 JAN 17 1 0 a 5.0 G