HomeMy Public PortalAbout9645 CRAIGLEE ST_Sewer__ FOR PERMIT
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DIVISION OF BUILDING AND SAFETY S EW E-R®SEWAGE DISPOSAL
CCC..LJJI
Department of County Engineer
County of Los Angeles BUILDING C—
WM. J. FOX. COUNTY ENGINEER ADDRESS. 67
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR.APPLICANT TO FILL IN NEAREST /
_ CROSS ST. ` - � ,/
LEGAL
DESCRIPTION LOT NO, OWNER
BLOCK TRACT ;� MAIL
� �y ADDRESS
SIZE OF LOT /
/ ^ y NOW ONBLOTS yG CITY TEL. NO..
USE OF
BUILDINGS. �t /�/' DISTRICT NO. GROUP MAP _
BIC PG
CONTRACTORG9� �i��C/h9
ADDRESS , COiaiIYEC'TION DATA Ir
CIT / �,, y e� TEL. NO. STATION t} C i DEPTH r
C7 STATE &ANHOLE REFERENCE ! +
REGISTRATION NO. /JNA^ Ele COUNTY UPPER (�.- g,(�!i/��L, OWER
✓ �>O — TYPE OF CONNECTION LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB /P L], M.L.TO P.L.
HOUSE SEWER CONNECTING TO t '
PUBLIC SEWER t@ $ 3.50
•HOUSE SEWER CONNECTING TO -
"PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR
_ WORK TO HOUSE SEWER 1.00' CO. IMP. N0. ` JOB. NO.
ALTER OR REPAIR EXISTING
'SEWER OR DISPOSAL SYSTEM 1.00 a 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
O@Vms PERMIT $ 1 00
AUTHORIZATION TOTAL FEE' REIMBURSEMENT FEE
I HAVE THIS DATE-CbNTRACTED WITH T HEREIN NAMED CON- -
TRACTOR TO CONNECT THE ABOVE DESC D EXISTING DWELLING APPROVALS - DATE INSPECTOR'S SIGNATURE
. TO THE PUBLIC SEW
SIGNED THIS AY OF 1 NEW HOUSE SEWER
6I
OWNER OR '� 'y' %F� CONNECT'ADDITIONAL _
OWNERS AGENT 666fff 1� � l" c's BUILDING OR WORK
ADDRESS ;0 e' SEPTIC TANK, SEEP, PIT(S)'
AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El DRYWELL[3A
ND 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
ABANDON HOUSE SEW D
CALIFORNIA OR THAT. AM THE LEGAL NER OF.THE ABOVE
DESCRIBED RESIDENTIAL PROP TY: BACKFILL SEPTIC_ TANKS❑
SEEP:PITS) ❑ CESSPOOLS
SIGNATUREOF PERMITTEE—
WILLIAM
ERMITTEE WILLIAM J.FOX, COUNTY ENGINEER VALIDATION
07BY 0 8 LfR SEP 9 4 4.� U
BY A' to
DEPUTY DEPUTY
BY BY
.'� DEPUTY - DEPUTY