HomeMy Public PortalAbout9622 CRAIGLEE ST_Sewer__ 76AG42D AA Il LI` ATI O , FOR PERMIT
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5&E-663 3.55
DIVISION OF BUILDING AND SAFETY SEWER®S EWAG E MI S POSA L
Department of County Engineer
County-of Los Angeles BUILDING
WAN.J. FOX. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN,SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST.
CROSS ST,
LEGAL
DESCRIPTION LOT NO. �jOWN ER
BLOCK TRACT ! d �j 7 MAIL
ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT �/ CITY TEL. N0. .�
USE OF
BUILDINGS. DISTRICT NO.,.. GROUP MAP
CONTRACTOR
�' I NKlt 4
ADDRESS r ' CONNECTION DATA
CITY OtTEL. N0. o STATION �a A DEPTH
ATE MANHOLE REFERENCE `72 S(f ITOWE R
REGISTRATION NO. "i D`�� ❑ COUNTY •G
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTf� LENGTH FROM
HOUSE SEWER CONNECTING TO `� Y. CURB Or•L•/ M.L. TO P.L.
PUBLIC SEWER - @ $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDG. OR P. C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. � C./O JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 •PERM IT*NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD. 3.00 INDUSTRIAL '
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES '
CONNECTION CHARGE FEE
OWNER'S PERMIT" .F, 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS. DATE CONTRA TED WITH THE HE EIN NAMED CON-
TRACTOR TO CONNECT THE BOVE DESCRI ED EXISTING DWELLING APPROVALS DATE INSPECTOR'SSIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS AY OF 1 NEW HOUSE SEWER ` _� /f.�
OWNER OR CONNECT ADDITIONAL v
OWNERS AG NT' BUILDING OR WORK
4. SEPTIC TANK, SEEP,-PIT(S) -
ADDRESS AND/OR DRAINFIELD
1 HEREB11 ACKNOWLEW6T7HAT IHAYIREAD AA A LIGATION- CESSPOOL[3DRYWELL❑ "
AND STATE THAT THE 'ROVE IS C.RRgar AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPA(R.SEWER OR ,
PLUMBING AND SEWERS. ,SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIAL PROPERTY, '+ BACKFILL SEPTIC TANKS❑ / r .r
SEEP. PIT(S) ❑ CESSPOOLS f7 'U
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX.COUNTY ENGINEER VAIMATIONR.A.WOOD, CHIEF PLBG. INSPECTOR
1 a.`7 :5 01 APR 2 4 4. 450 '�