HomeMy Public PortalAbout9628 CRAIGLEE ST_Sewer__ D
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING, p y^ `-
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS �d G�/ ., L'3 L�o -.
® CASSATT D. GRIFFIN, SUPT OF BUILDING " LOCALITY-7_�Pj E - C I(Y L A C-3 i I<
FOR APPLICANT TO FILL IN :ROSS ST' eA4P% `8r E
z LEGAL - r�. -
y DESCRIPTION LOT NO.--Z OWNE
BLOCK TRACT IIDDRESS�(8��
Lr-- Q NO.-OF BLDGS. CITY&j { TEL. NO. / �+ •��yy
r SIZE OF LOT l 'NOW ON LOT V -
u. USE OF
a � ° NINGROUP MAPBUILDDISTRICT
L� ) BK PG
e CONTRACTOR
CO/NNECTION DATA
ADDRESS
STATION
STATION �'� V
DEPTH
CITY - EL. NO - MANHOLE REFERENCE
' ii ❑ STATE - LOWER
REGISTRATION-NO. �v ❑.COUNTY g
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ,P. TYPE OF CONNECTIO -LENGTH FROM /
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD /y P. C. N0. -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. N0. 11 /0 JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM - @ $1.00 ` TRUNK PERMIT NO. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG.OR e 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 CHARLIE FEE
i
OWNER'S PERMIToo
AUTHORIZATION TOTAL FEE $ ' r( REIMBURSEMENT FEE G
1
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER NEW HOUSE SEWERS •�-' '
SIGNED THIS .19 1DAYO F19 —
w CONNECT ADDITIONAL.
OWNER OR- BUILDING OR WORK
OWNERS QE A SE PTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDG (HAT i HAVE READ THS APPLICA N a
AND STATE THAT THE ABS E IS CORRECT AND AGREE TO COWFLY .._� CESSPOOL❑ DRYWELL❑--
•WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAT OF - ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGA WNER OF THE VE
DESCRIBED RES]DENTIA PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) El CESSPOOLS �� -��11(��••
s OF PERMITTEE .
JOHN A. LAMBIE,COUNTY ENGINEER VALIDATIODL_ ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. m.0. CASH
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