HomeMy Public PortalAbout9616 CRAIGLEE ST_Sewer__ S&E-663411.55 A PLI`L:J�'UTMN FOR. u Intl UMT
-DIVISION OF BUILDING ARID-SAFETY SEWER-SEWAGE D O S POSA L
Deportment of County Engineer
County of Los Angeles 6uILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT of BUILDING. LOCALITY C '
`.FOR APPLICANT TO FILL IN CROSS ST.
LEGAL - 3 0 OWNER
DESCRIPTION LOT N0. �y/�ipug
ol� 7 MAIL
BLOCK - TRACT ADDRESS `
NO, OF BLDGS. CITY TEL. NO.
SIZE OF LOT - N WON LOT
USE OF -
BUILDINGS DISTRICT NO. BK PG._ GROUP MAP `
'�
_
TCONTRACTOR 9 5—
„( .
CONNECTION DATA
ADDRESS ffrowl "
t STATION l"' '7/a DEPTH
CITY EL. NO.
MANHOLE REFERENCE IPER
REGISTRATI N NO. v ❑ COUNTY '•^'"`" O E
t?
NO. DESCRIPTION OF K FEE
HOUSE SEWER CONNECTING TOTYPE OF'CONNECTIO LENGTH FROM G7
Y. CURB L. M.L. TO P.L.
PUBLIC SEWER @ $3+01003+45-1-10
SEPTIC TANK,'SEEPAGE PIT OR
PITS AND/OR DRAINFIELD a $3 -
OVERFLOW SEEPAGE PIT, DRAINFIELD - a i P, C. N0. ,
EXTN.;CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP. NO.- / � �. JOB NO. -
HOUSE SEWER'CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1.0.0 �' TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER . @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 - WASTE APPROVAL - -
CHARGES
CONNECTION CHARGE FEE - '
OWNER'S . PERMIT $ 1. 00
-= REIMBURSEMENT FEE.
AUTHORIZATION I' TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON-
}' APPROVAL.? DATE INSPECTORS SIGNATURE
TRACTOR TO CONNE TH ABOVE DE IBED XISTING DWELLING
TO THE PUBLIC SEW - NEW HOUSE SEWER
SIGNED THIS AY OF 115-7 CONNECT ADDITIONAL
OWNER. OR BUILDING OR WORK–
OWNERS AGE
ORK.OWNERSAGE6 ��
_ SEPTIC TANK;SEEP,PIT(S) - -
ADORE SS AND/OR DRAINFIELD' "
I HERE Y ACKNO EDGE T I HAV REA5 THIS APPLICATION CESSPOOL❑' DRYW ELL❑
ANDSTATETHAT HE ABOV CORRECT AND AGREE TO COMPLY - '
WITH ALL COUNTY ORDINA ES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING" AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY A D STATE OF n. ABANDON HOUSE SEWER
CALIFORNIA OR THAT !1 AM "LEGAL NER. T D
All V
RDENZ& PROPE BACKFILL SEPTIC TANKS[3
SEEP.PIT(S) ❑ CESSPOOLS ,
PER TT
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIO ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
CK. 61.0. CAS "' _