HomeMy Public PortalAbout4844 FRATUS DR_Sewer__ E 6D
5&E89 11 55 APPLICATION FOR PERMIT _ 1
S& 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY r
FOR APPLICANT TO FILL IN CROSS sT
LEGAL / OWNER
DESCRIPTION LOT NO '
E 4U,
y w MAIL —,1/1
BLOCK TRACT �/�%t ADDRESS �
NO OF BLDGS / ije CITYTEL NO rr, "y/0-5SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS Q--�- DISTRICT NO GROUP MAP
P�
CONTRACTOR
ADDRESS/-.���V� �(� c CONNECTION DATA
LIQ.
STATION LO DEPTH
CITY TEL NO
// 7 l�D7 ❑ STATE MANHOLE REFERENCE UP R
REGISTRATION NO
J /� ` /O� IEFY W E R
NO DESCRIPTION OF WORK FEE <
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM a,
PUBLIC SEWER @ $3 50 L7 3� Y CURB L M L TOP L o
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO -z
EXTN CESSPOOL DRYWELL,MANHOLE @ $2 00 CO IMP NO J4�CL0
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 HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ t 00
AUTHORIZATION I TOTAL FEE
15--T-) REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSIPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY 79 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS11,00' AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
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 RESIDENTIAL PROPE BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
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JOHN A LAMBIE COUNTY tNGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
,CK H 0 CASH '
UA�o 9 1 2 4 JA 11 4 4.5 0 �)