HomeMy Public PortalAbout9629 CRAIGLEE ST_Sewer__ DIVIS_ON OF BUILDING AND SAFETY SEWER-SEWAGE MSPOSA' L
Deportmeat of County Engineer G •
County Of LOS Angeles: [- BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
®
CASS ATT D. GRIFFIN, SUPT OF BUILDING • LOCALITY
:a
FOR APPLICANT TO FILL IN CROSS s.
LEGAL '•
�^ DESCRIPTION LOT N0. c OWNER -
rr MAIL
BLOCK- TRACT i �y7 ADDRESS
NO. OF BL d
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO, ~GROUP MAP
BUILDINGS _
{ BK - PG
s CONTRACTOR
ADDRESS CONNECTION DATA JJ
Y A •
z STATION .�� —• DEPTH -
CITYNO. MANHOLE REFERENCE /, UPPE
REGISTRATION NO. � If El COUNTY _
NO. DESCRIPTION OF.WORK FEE TYPE OF CONNECTION LENGTH FROM /
HOUSE SEWER CONNECTING TO Y. CURB .L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 3.00 R
m OVERFLOW SEEPAGE PIT, DRAINFIELD -
P. C. N0.
_ EXTN.,CESSPOOL,DRYWELL,M AN HOLE @ $2.00 CO. IMP. NO. -�� �/ / JOB NO.
HOUSE SEWER CONNECTING TO - - •
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. 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
m CONNECTION CHARGE FEE -
OWNERS PERMIT $ 1 00
REIMBURSEMENTEE
AUTHORIZATION TOTAL.FEE tFT � t«�
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED'CO. APPROVALS DATE:- INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �/
TO THE PUBLIC SEWER. NEW HOUSE SEWER. CL.G '
SIGNED THIS
DAY OF _19, CONNECT ADDITIONAL-
OWNER OR * BUILDING OR WORK - -
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
y ADDRESS AND/OR DRAINFIELD
'.` I HEREBY ACKNOWLEDG THAT I HAVE RFjD THIS APPLICATION e
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 OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ _ �',_•[��
SEEP. PIT(S) Cl CESSPOOLS o fj
L- SIGNATURE
6
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH
L: 1 5.9 CS .1J# . -6 4 A4-50
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING s G: NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
-CROSS-ST.
�''"/ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER G.l . i/•.i C b1 A G�C �
MAIL ` J
ADDRESS USEZONE OCCUPANCY MAP
BK PG
CITY LL tj TELAO. —� I
CONTRACTOR ff� CHARGES REIMBURSEMENT FEE
ADDRESS. [� ,y'� REQUIRED
— TL ` A NOT REQUIRED
CITY v L.NO. 3 {f
JOB.NO. CONNECTION CHARGE FEE
STATE
REGISTRATION NO. COUNTY CO.IMP. NO.
LEGAL RECEIPT NO. DATE BY
DESCRIPTION LOT NO.
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLDGS.
USE OF NOW ON LOT RECEIPT NO. I DATE BY
BUILDINGS
NO. DESCRIPTION OF WORK FEE TRUNK PERMIT N0.
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLICSEWER @ $ 3.50
HOUSE SEWER CONNECTING TO !�y. STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM L00 / V C� PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION DEPTH
PTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL UPPER LOWER
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ I 00 ---
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CO?NTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS------------------DAY OF---........-............................ 19....-.-- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------........... ........... .................... BUILDING OR WORK
------- .---_-__.__-------- SEPTIC TANK,SEEP.PIT(S)
ADDRESS------------------
------------•--------------------------.--- AND/0 R D RA I N F I E L D
I HEREBY ACKNOWLEDGE THAT I 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,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE .�� O�� SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE.&�.. 4R!�-_-'^ .
i6A642D 663 12/52
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