HomeMy Public PortalAbout4847 FRATUS DR_Sewer__ 78A8
S APPLICATION FOR PERMIT - 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL'
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A: LAMBIE, COUNTY ENGINEER _ADDRESS
® - CASSATT D. GRIFFIN, SUPT of BUILDING -
'LOCALITY
FOR APPLICANT TO.FILL IN CROSS T. it "
LEGAL OWNER
DESCRIPTION LOT NO. z - I
MAIL
BLOCK TRACT !A DRESS
NO. OF BLDGS. //'�_r
SIZE OF LOT- NOW ON LOT (CITY - TEL.-NO. LQ
USE OF GROUP MAP DISTRICT NO,
BUILDINGS -/-y--- %K�
P
CONTRACTO - � i
ADDRESS -6 } — CONNECTION DATA -
/�/� ` �- / Q
CITY - �,(f'a✓� / • TEL. NODEPTH
.�zf (? STATION MANHOLE REFERENCE UPPER
STATE
REGISTRATION N0. //,�.b,lC— ❑,�- {Y
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIONLENGTH FROM
HOUSE SEWER CONNECTING TO !J ,lid Y. CURB M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR '
. PITS AND/OR DRAINFIELD Q $3.00 '�-
OVERFLOW SEEPAGE PIT, DRAINFIELD {. P. C. N0,
EXTN.,CESSPOOL,DRYWELL,MAN HOLE Q. $2.00 CO. IMP. NO. __:"I.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM - Q $1 00 TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER Q $1.00 PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $_1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE'PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS D F 19 CONNECT ADDITIONAL _ XX
OWNER .OR - BUILDING OR WORK
OWNERS AGENT- _ SEPTIC TANK,'SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWDISCONNECT PLUG AND
CALIFORNIA OR THAT I AM T LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTLAL PRO RT BACKFILL SEPTIC TANKS❑
SIGNATURE _ SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMIT. r
JOHN A. LAMBIE, COON ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
CK. d O. CASH '�"