HomeMy Public PortalAbout9633 CRAIGLEE ST_Sewer__ 78A642D APPLICATION `FOR PERMT
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DIVISION OF BUILDING AND SAFM SEWER®S EWAG E "D 0 S POSA L
Deportment of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
- CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN ceoss sT.
LEGAL g_/ -
DESCRIPTION LOT NO. // OWNER
BLOCK TRACT / 6 7 MAIL '
ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS -� DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
ADDRESS �6 �,,, - CONNECTION DATA
CITY TEL. NO. STATION DEPTH
y+�
REGISTRXe ON'NO.. ® � ❑ COUSTANTY TY � MAN REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM 9 y�
No. DESCRIPTION OF WORK FEESALM P.L. M.L.TO P.L. LI V
HOUSE SEWER CONNECTING TO
PUBLIC SEWER' Q $ 3.50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM - 1.00_
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. ,lJ V/ 'JOB. NO.
WORK TO HOUSE SEWER 1.00
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 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL -
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
ov;mis PERMIT S _ 1 00
AUTHORIZATYON TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED.WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT-THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER" e/
OWNER OR 1 � �� CONNECT ADDITIONAL
OWNERS AGENT ',f BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS 'AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT-THE ABOVE IS-CORRECT AND AGREE TO COMPLY
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 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) ❑ CESSPOOLS •)_([, (-%J(l I-1 I�Ydy .
SIGNATURE p
OF PERMITTEE - ti
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY f"No 6 .9 sr 6�AUG 2 2 4 4.5 0 �
�'. DEPUTY - DEPUTY
BY
BY o `
0 DEPUTY' DEPUTY -
76A64 10-82 APPLICATION
(CATION ICOR PERMIT 78 A 842 D /`�If�I�ice. f�i1 �tl tl�' r l�u o
COUNTY OF LOS ANGELES SE*WER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING / A
JOHN A. LAMBIE, County Engineer ADOREss
WILLIAM A. JENSEN. Sup't of Building Tj)� fJ ,
LOCALITY / f"L
NEAREST y /
FOR APPLICANT TO FILL IN `ROSS ST.
LEGAL
DESCJ
RIPTION LOT NO. OWNER m
MAIL
BLOCK TRACT (D
ADDRESS (/' �'�' Z► I •L
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY 7 TEL. -NO.
USE OF i . .. ,:...-...•_�..,,
BUILDINGS -��/ DISTRICT NO. GROUP MAP/) /'/ PROCESSED BY
J^ � /V
-- /BK P /
CONTRACTOR e -7, a � N / - �
ADDRESS 1 ,9 �/c e 5 d CONNECTION DATA
CITY �( le— L/ , NO. ��7– y9 �L� STATION DEPTH
E]STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $5.00 O
P.C.NO. 0
SEPTIC TANK,SEEPAGE PIT OR JOB NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00 h
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I ASEMENT I RECORD.INSTR.NO. DATE (u
WORK TO HOUSE SEWER @ $3.00 (L
OVERFLOW SEEPAGE PIT,DRAINFIELD V)
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 _ HWY.OR ST.WIDENING
ALTER, HOUSE
SEWER a ' SYSTEM @ f3.00 U 0 STATE ENCROACHMENTo '
PERMIT NO.
h./ INDUSTRIAL
WASTE APPROVAL
OWNER'S' PERMIT $ 21 00 CHARGES
AUTHORIZATION TOTAL FEE 0/1 CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CORN- REIMBURSEMENT FEE
TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLISEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
a
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REF7pPR,SEWEWUR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF G5ElA4AJa6.A.45P�SA{a-S1yGEM �� - A')
CALIFORNIA OR THAT I AM T E LEG L OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE D RIBED ESID TIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE ^ BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP,PITS) E3 CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
cK` m.O. CASH SUPERVISING MECHANICAL ENGINEER
d Lp,G06 4 6 7% tIAR 11 1 0 D 5.00-.