HomeMy Public PortalAbout4853 FRATUS DR_Sewer__ D
S&E-669 11.55 APPLICATION FOR PERMIT. 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County ELBUILD]
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County of Los AngeBUILDING
JOHN A. LAMBIE, COUNTYEER ADDRESS
® CASSATT D. GRIFFIN, SUPT ONo LOCALITYNEAREST
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FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT N0. �rJ
BLOCK TRACT �1-9 S.:;_1 / ADDRE
NO.OF BLDGS. CITY TEL. NO
SIZE OF LOT NOW ON LOT
USE OF /r �¢_ -
BUILDINGS l DISTRICT N0. GROUP MAP -
CONTRACTOR BK^ �P`�
ADDRESS
CONNECTION DATA
C,-T_1
� STATION���Q�j DEPTH
CITY TEL. NO. MANHOLE REFERENCE UPPER
l
STATE
REGISTRATION N0. G ��--�.— y� ❑❑ r OWER
n
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIO 1 LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB 'P.L M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. +-tnu N� -•
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 @ $100 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00- WASTE APPROVAL -
CHARGES-
CONNECTION CHARGE-FEE
OWNERS PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE IN ECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER. NEW HOUSE SEWER ^
SIGNED THIS DAY PE 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
-ADDRESS PND/OR DRAINFIELD .
I HEREBY ACKNOWLEDGE THAT I 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COU.NFY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNE OF THE ABOVE
DESCRIBED RESIDENTIAL PROP TY BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMI
JOHN A. LAMBIE. COUNTY ENGINE09 VALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
✓-- � �� CK. N 0. CASH
�G 2 Juv 11 4 4.5, 0 �,