HomeMy Public PortalAbout9650 CRAIGLEE ST_Sewer__ 76A642D
CE 808(REV.6/781 APPL--OCS TO N OR PERM OT -
SEWER - SEWAGE ®OSP®SAL
COUNTY OF LOS ANGELES BUILDING ARID,SAFETY '
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP MAP. ,P CESSED BY
1 BK PG
BUILDING. C % '
ADDRESS ;:` {+ - �L^�G� -3 � 'y .-
,, ; 'CONNECTION DATA o
LOCALITY - -
NEAREST STATION jy� ,/��• DEPTH Y I
/ S ✓✓y
CROSS ST. �✓
MANHOLE REFERENCE "
'UPPER
,OWNER
.OWNER -
_ •TYPE OF CONNECTION _ LENGTH FROM -
MAIL - �- Y. C
DDRESS URB .L „3 M.L.TO P:L.
A �� '
P.C.NO.
CO.IMP.NO. JOB NO.
CITY G 1 TEL.NO.
' LEGAL1 TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. ON141n/ 1,-/--7_
AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO: DATE
� '
BLOCK TRACT 3..'~ `
NO..OF BLDGS. ,
SIZE OF LOT NOW ON,LOT I. HWY.OR ST..WIDENING ,
USE OF
BUILDINGS �;/�i��p C' � '�/"J %:G• STATE ENCROACHMENT ,
PERMIT NO.
INDUSTRIAL
'.CONTRACTOR ��d / /'T� WASTE A PROVAL
ADDRESS Z,C , �^�/ff�y' CHARGES
CITY TEL. O.
�.�/'/ 7 CONNECTION CHARGE FEE
"� ./L� NI �'7 `f7� �
STATE `' LIC. REIMBURSEMENT FEE
LICENSE NO. - CLASS Ip -`,
NO. DESCRIPTION OF WORK FEE APPROVALS , DATE INSPECT(]R'S SIGN ATURE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER r
SEPTIC'TANK,'SEEPAGE PIT OR NEW HOUSE SEWERIQO�
PITS AND/OR DRAINFIELD
CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
SEPTIC/OR DRAINFIELD SEEP,PIT(S) NiL
CONNECT,TOOU ADDITIONAL BLDG.OR AND/OR DRAINFIELD 5577
- WORK TO HOUSE SEWER - � "o
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL Cl DRYWELL❑
EXTN.,CESSPOOL.DRYWELL;MANHOLE
ALTER,REPAIR OR ABANDON HOUSE ALTER.REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
_ BACKFILL SEPTIC TANKS❑ ..
SEEP,PITISI[:1 CESSPOOLS El
OWNEl4'S Permit � ~
VALIDATION
AUTHORIZATION TOTAL FEE
I HAVE AT THIS,.DATE'A CONTRACT WITH THE HEREIN NAMED CON-.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. y� g 91 �• 0
SIGNEDTHIS '�// DAY OF /L�-y�i 7� '
OWNER OR /j,�_ O•O 0 O 1-0. .
•OWNERS AGENT
ADDRESS 2 a o 1000-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION L
AND STATE THAT THE ABOVE ISL CORRECT AND AGREE TO COMPLY q q O 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Q O O t C7< pJ
PLUMBING AND SEWERS. - -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR • ' ^ ^^
1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 1/ /G�+
CALIFORNIA OR THAT AM THE LEGAL OWNER OF.AND INTEND TO RE-
SIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. '
SIGNATURE - -
OF PERMITTFT ���
(1 (�� I�9� Qsq�� C
S'&E-6 D A P P 41m�C A T�®11 V FOR U P Lia tl tl tl V�EI I 0
3'&E-88311.55
DIVISION OF BUILDING ARID. SAFETY S EW E P�-����(G ®9 S P® L
Deportment of County Engineer
County_oi Los AngelesY BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
All
® •CASSATT D. GRIFFIN, SUPT OF BUILDING € LOCALITY
NEAREST - -
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. ,.� G SA�Q'�'�`I Dt OWNER ^ ��
MAIL
BLOCK Tm;wr 9 L A`':l �"n� ADDRESS
r NO. OF BLDGS. CITY - TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF - •DISTRICT NO. GROUP- MAP
BUILDINGS I BK PG
CONTRACTOR
CONNECTION DATA.
ADDRESS '
CITY ELN
STATION - DEPTH
T . O. -
MANHOLE-REFERENCEUPPER
❑ STATE 51f
REGISTRATION NO. ❑ COUNTY - -
No. 1. DESCRIPTION OF WORK FEE
,HOUSE SEWER-CONNECTING TO - TYPE"OF TION LENGTH FROM .. J
Y. �� P.L. M.L.TO P.L. _7
PUBLIC SEWER @ $ 3.50
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR'DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $ 2.00, CO..IMP. NO./.,3 3 �. JOB NO:
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO..
CONNECT ADDITIONAL BLDG.OR _ - STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSEINDUSTRIAL -
SEWER OR DISPOSAL SYSTEM @. $1.00 _-WASTE APPROVAL - -'
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00 '
AUTHORIZATION TOTAL FEE t REIMBURSEMENT FEE,, �1J
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE "IN S,PQE.C�TO R'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
S - �• NEW HOUSE SEWER SR,!
/_�
SIGNED THIS OF 79 0 ' CONNECT ADDITIONAL - - Q
" OWNER OR BUILDING OR WORK
OWNERS AGENT _ SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD - '
1 HEREBY ACK OWLEDGE THAT 1 HAVE READ IS APPLICATION CESSPOOL❑ DRYWELL-❑
AND STATE THAT THE ABOVE IS CORRECT' AND REE TO'COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW.S REGULATING - ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFYTHAT 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 RESIDENTIA.L PROPERTY "SEEP.FPIT(S)ILL P❑ CESSP00TIC TANKS❑LS (3 X' ,�:�//T+i^�^ '/ •.
SIGNATURE - -
OF PERMITTEE
2-
JOHN
JOHN A. LAMBIE, COUNTY E5NGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0. CASH - - - -