HomeMy Public PortalAbout4854 FRATUS DR_Sewer__ D
S&E-6eAPPLICATION F013F013PERMIT
S&E BDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING 4/,_ }�7
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 41
�
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
AiL
FOR APPLICANT TO FILL IN CROSS sT /
LEGAL OWNER
DESCRIPTION LOT NO /
MAIL
BLOCK TRACT Ann� � ADDRES ,(
NO OF BLDGS CITY TEL NO�/ �UJ
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP MAP
BUILDINGS .,��
P
CONTRACTOR `PGS
ADDRESS ' � � CONNECTION DATA `/(J
CITY TEL NO STATION �Z, S DEPTH
MANHOLE REFERENCE . UPPER
0 STATE
REGISTRATION NO .. -
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM
PUBLIC SEWER @ $3 50 Y URB P L M L TO P L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P.0 NO
EXTN CESSPOOL,DRYWELL,MANHOLE @ $ 2 00 CO IMP NO
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM t@ $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 n $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
-1-/ REIMBURSEMENT FEE_
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE IN PECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY g�- 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT 1 AM TH GA OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTI PROPE; BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITT
JOHN A LAMBIE COUN ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK Id 0 CASH
�}�Uo 9 1 2 5- JUUM 11 4 4.5 0