HomeMy Public PortalAbout9623 CRAIGLEE ST_Sewer__ DEPARTiiViENT OF COUNTY ENGINFIER SEWER-SEWAGE ®USPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION-
COUNTY OF LOS ANGET SNG
/
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT TO FILL IN
LOCALITY �Qo .��f Q dmid d
BUILDING ST,
ADDRESS CROSS CROSS ST
LOCALITY DISTRICT NO. — I SERIAL NO. PERMIT NO. C
NEAREST S
CROSS ST.
RECEIVED BY Ready for Inspection DATEISSUED
OWNER Q /!r� 13pmom/ a / I —/ I –`.Q
MAIL ` USE ZONE OCCUPANCY MAP
ADDRESS m / I I BK PG
CITY TELpO. a
CONTRACTOR �' n[ aM�b� ra — CO.IMP.NO.
ADORES S Q A 4JOB.NO.
CITY TEL-NO. TRUNK PERMIT NO.
REGISTRATION, 0. &k STAT E
62® COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE IBY
HOUSE SEWER CONNECTING TO / 00PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 V MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I I D
CONTRACTORHAVE
TO CONNECT THEDATE
ED ABOVE DESCRIBED IEXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS......._......_...DAY OF-..._._-._._...-.__-.-.___19_-_ NEW HOUSE SEWER -/Z,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------_------
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS............................._...................................................... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE `
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,RE)iAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY y DISCONNECT ABANDON HOPLUG PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
?i ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
4
OF PERMITTEE ... -... `v': ............
76A642A 663 7/53
APPUCATMN FOR PERMIT-
seeos•s-se . COUNTY`OF LOS ANGELES SEWER�-SEWAGE- DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING... / /^
JOHN A. LAIE, County Engineer' ADDRESS
MS
CASSATT A GRIFFIN, Supt of Building LOCALITY Lir T
m NEAREST' I
FOR APPLICANT TO FILL IN ceoss sr:LEAL
` DESCRIPTION LOT NO. �6 fp ' OWNER
BLOCK TRACT ��® I`�®
ADDRESS
c2 O.OF BLDGS. -—" _
SIZE OF LO1�✓/X� / OW ON LOT CITY TEL.NO.
USE OF
BUILDINGS ! La G DISTRICT NO. GROUP BK MAP PROCESSED BY
Y P6
CONTRACTOR
ADDRESS, o 4/ CONNECTION DATA
CIT TEL. NO. — STATION �, DEPTH
/ e
R"�CIO TE ; MANHOLE REFERENCE
REGISTRATION N0. ^7" COUNTY '.
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 v
SEPTIC TANK,SEEPAGE PIT OR ;TYPE OF CONNECTION,. % LENGTH FROM..
PITS AND/OR DRAINFIELD @ $3.00 ' Y. CURB / .L.\ M.L.TO 1.L. /
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
n HOUSE SEWER CONNECTING TO - P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 - - CO.IMP.NO. [ JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK-PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER - @ $1.00 a
�o SEWER OR ISPOSAL SYSTEM HOUSE @ $1 00 r STATE ENCROACHMENT .
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER•S pggLglT 2100
CONNECTION CHARGE FEE"
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. f ,APPROVALS DATE" INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. -
SIGNED THIS DN' OFNEW HOUSE SEWER.
?� OWNER OR ,� CONNECT ADDITIONAL
OWNERS AGENT ✓ BUILDING OR WORK
SEPTIC.TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD _
I HEREB ACKNOWLEDGE THAT I AVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE.OFABANDON HOUSE SEWER
CALIFORNIA OR THAT I IM THE LEGAL OWNER OF THE'ABOVE
DESCRIBED RESIDENTIA P 'OPERTY. BACKFILL SEPTIC TANKS❑ '
SEEP. PIT(S) O CESSPOOLS c
SIGNATURE
OF PERMFI (
Kry:G - P. •di
®F -._ VALIDATIO ROBERTA.WOOD
CK: M.0. CASH SUPERVISING MECHANICAL ENGINEER
LAP 7 053 m VIV ?6 1 0 500 ta