HomeMy Public PortalAbout9751 CRAIGLEE ST_Sewer__ -61
76A6423-61
APPLICATI FOR PERMIT
76A 642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engin�e� ADDR
WILLIAM A. JENSEN, Supt of Building— LOCALITY
NEAREST iloor
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT N0:"
BLOCKTRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CI TEL. NO
USE OF
BUILDING DISTRICTN GROUP BK MAP PG PR CE D BY
CONTACTO f � 3
ADDRESS CGCG CTI D TA
CI _ TEL.N0. STATION DEPTH
/
STATE MANHOLE REFERENCE "� UPP
REGISTRATION N0. 7./ COUNTY
No. I DESCRIPTION'OF WORK FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8,00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00 °-
HOUSE SEWER CONNECTING TO P.C.NO. [ _ O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0. �� U
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT O
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. V
Lu
INDUSTRIAL a
WASTE APPROVAL N
CHARGES z
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE dQ REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEREINAMED CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS ( OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT t 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
I CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LIABANDON HOUSE SEWER
CALIFORNIA OR THA 1 AM THY LEGAL OWNER OF HE ABOVE BACKFILL SEPTIC TANKS [IDESCRIBED OR L PROPE SEEP.PIT(S) ❑ CESSPOOLS
SIGNATURE C
OF PERMITTE
VAUDATIO ROBERT A. WOOD
CL M.o. f) SUPERVISING MECHANICAL ENGINEER
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