HomeMy Public PortalAbout9721 CRAIGLEE ST_Sewer__ TTEMPLE CITY
76AS42D.:.� tl�lp ����f/'V U �ON FOR PERMOT �!
ceaoa sa COUNTY OF LOS ANGELES ,
= SEWER—SEWAGE ®BSS®SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMMIE, Count)r Mn neer ADDRESS
CASSATT D. GRIFFIN, Sup t of Building LOCALITY :1
NEAREST
FOR APP ANT TQ: CROSS ST. r
LEGALe�LOWNER
DESCRIPTION LOT NO. -
i
BLOCKMAIL
TRACT ADDRESS
0.OF BEGS.
SIZE OF LOT NOW ON.LOT CITY TEL. NO. bi
USE OF
BUILDINGS DISTRICT NO. GROUP MAP �PROCASE7.BYT
3 / BK PG�
CONTRACT 8
ADDRESS* �' CONNECTION DATA
a ,
CITY TEL.N0. l STT N' DEPTH
ATE MANHOLE R FER NCE
REGISTRATION N0. � (� COUNTY LOWER
No. DESCRIP O OF WORK FEE
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3.bo T P OF 00 LENGTH FROM l
SEPTIC TANK,SEEPAGE PIT OR f L. M.L.TO P.L.
y PITS AND/OR DRAINFIELD @ $310 _
OVERFLOW SEEPAGE'PIT.,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2110 '
HOUSE SEW ER.CONNECTING TO - P.C.•NO. - -
PRIVATE DISPOSAL SYSTEM @ $1. 0 r CO.IMP. N0. JOB NO.
CONNECT ADDITIONAL BLDG:OR - - TRUNK PERMIT NO. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1, 0 <
REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
-
D kwOR DISPOSA SYSTEM @ $l. 0 - PERMIT NO.
I USTRIAL
W TE APPROVAL -
OWNERS PERMIT CONNECTION CHARGE FEE '
AUTHORIZATION TOTAL FEE Q REIMBURSEMENT FEE
1 HAVE AT THIS-DATE A CONTRACT WITH-THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED. EXISTING DWELLING APPROVALS DATE. INSPECTOR'S SIGNATURE
TO THE-PUBLIC SEWER. -
SIGNED THIS DAY OF 19_ 6;, NEW HOUSE SEWER
> OWNER OR CONNECT,ADDITIONAL
OWNERS AGENT BUILDING OR-WORK
SEPTLC TANK;SEEP.PIT(S) -
ADDRESS AND/OR DRAINFIELD
y? I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION
s9 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS .REGULATING ta` ALTER,-REPAIR,SEWER OR
.PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM - -
> f 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 OWN OF THE ABOVE ',,.
,x DESCRIBED RESIDE L PROP RTY, _ BACKFILL SEPTIC TANKS ❑
SEEP. PIT.(S) ❑ CESSPOOLS ❑
SIGNATURE
OF PERMIT.
®F ALIDATION ROBERT A. WOOD
Ca X.0. CASH SUPERVISING MECHANICAL ENGINEER
L`w6737b HHV g 11 D >2500- y
TEMPLE CHS" '
canoe a-5e APP
COUNTY OF LOS ANGELES 'SEWER-SEWAGE DOSPOSAL
DEPARTMENT OF COUNTY ENGINEER
s
BUILDING AND SAFETY DIVISION BUILDING hh
ADDRESS
JOHN A. LAMBIE, Count Engineer
a G M1
CASSATT D. GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
-{ LEGAL OWNER
i DESCRIPTION LOT N0.
BLOCK - TRACT MAIL" .0111,
ADDRESS
0.OF BLDGS.
SIZE.OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDIBUILDI.NGS DISTRICT NO. GROUP MAP P OCES `BY
BK P
CONTRACTOR
ADDRESS ) CONNECTION DATA
CITY EL.NO, l� Q TION ✓ DEPTH/t/)'
EPTH �.
STATE gANHOLE dEFZRENCE• �j
REGISTRATION N0. / COUNTY LOWS
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ' "
PUBLIC SEWER, @ 64-00 LENGTH
SEPTIC TANK,SEEPAGE PIVOR TY E OF ON CT OIII LENGTH FROM /.
PITS AND/OR.DRAINFIELD @ III-00
pr M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD. '�
EXTN.. CESSPOOL. DRYWELL - A1.00 _
HOUSE SEWER CONNECTING TO_.
PRIVATE DISPOSAL SYSTEM 1.00 CO.IMP. N0. - JOB NO.
CONNECT ADDITIONAL BLDG.OR t. TRUNK.PERMIT NO. ROAD PERMIT N0.
g WORK TO HOUSE SEWER 1.00 <
ALTER,REPAIR OR ABANDON HOUSE - o STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM 1.00 PERMIT NO. -
INO STRIAL - -
WA E APPROV
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE.A CONTRACT WITH THE HEREIN fAMED CON- i
;i TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING `: APPROVALS 1DATE7 1NSPECTOR'SSIGNATURE
TO THE PUBLIC SEWER.
SIGNED-THIS-DAY OF 19, NEW HOUSE SEWER
OWNER OR -CONNECT ADDITIONAL I
T OWNERS AGENT BUILDING OR WORK
F
ADORES 11 AND/ORTDRAI�NFIELDPIT(S)-
1+, HEREBY ACKNOWLEDGE.THAT 1 HAVE READ THIS APPLICATION 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
1 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 RESIDEN L PROPS Y. BACKFILL SEPTIC TANKS
SIGNATURE ❑
", SEEP.
PIT
(S) ❑ CESSPOOLS ❑
✓ _
OF PERMITTE � '
OF VALIDATION ROBERT A. WOOD
M.0. CASH SUPERVISING MECHANICAL ENGINEER
L 0 6 / 3 6 o NOV 8 1 4 0 ' 7.a 0 v