HomeMy Public PortalAbout9750 CRAIGLEE ST_Sewer__ CE808 3-61
76A 642D
COUNTY OF LOS ANGELES SIEWER—SEWAGE DOSPOSAL
DEPARTMENT OF.. COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRES -
WILLIAM A. JENSEN, Supt of Building_ LOCALITY
NEAREST
FOR APPLICANT TO Ffll IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT N0:
BLOCK TRACT MAIL
ADDRESS
4 4-
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY L. NO.
USE OF
BUILDINGS <DISTRICT N0.I G UPMAP - P OCES D BY
i PG
CONTRACTO � •� f i r
ADDRESS C NNEC ON DATA
CITY TEL.NO. `� STATION � DEPTH
STATE MANHOLE REFERENCEUPPER
REGISTRATION NO. / COUNTY
No. I DE!CRIPTI N OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 �/ YPE OF CONflECT1 LENGTH FRO
SEPTIC PITS AND/OR DRAE FIELDSEPAGE PIT OR @ $3.00 Y. /CURB _ M.L.i0 P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD }.
EXTN..CESSPOOL.DRYWELL @ $2.00 p
HOUSE SEWER CONNECTING TO I P.C.NO. -:- - 6 O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. JOB NO. . � /
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 im
ALTER, OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. V
INDUSTRIAL Lu
a
.WASTE APPROVAL N
CHARGES Z
O 'R'S
PERMIT g 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 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 D OF 19_ NEW HOUSE SEWER »
OWNER OR CONNECT ADDITIONAL `
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE 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 AM THE LEGAL OWNER OF T ABOVE
DESCRIBED RESIDENT PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE Z__ SEEP.PIT(S) Cl CESSPOOLS
OF PERMITTEE
VAMATIOROBERT A. WOOD
CK. e.0. CASH SUPERVISING MECHANICAL ENGINEER