HomeMy Public PortalAbout4857 FRATUS DR_Sewer__ ,6^642° APPLICATION FOR PERMIT 1
S&E 663 11 55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING /��,�"� Cif � ✓
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS sT 7r
LEGAL 1 OWNER
DESCRIPTION LOT NO /
.1 MAIL
BLOCK TRACT -� ADDRS jV
16�NO OF BLDGS �/7 CITY
SIZE OF LOT NOW ON LOT F-
USE OF
BUILDINGS —, "E-' DISTRICT NO GROUP MAP
CONTRACTOR .,' T
CONNECTION DATA
ADDRESS X_ VeJ '` -' Q�-e
CITY TEL
`` _ � STATION a DEPTH
_ /C�� NO G MANHOLE REFERENCE UP
P
STATE WER
REGISTRATION NO </3- c-
'_ ''2 ❑[�.(}Ni'� t
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ,yam, TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 50 J Cl Y CURB ,P L / M L TO P L T
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD c+ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO e�
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO ,Ing NG
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 $ 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 DAA OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT r�� SEPTIC TANK,SEEP, PITS)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLED E 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
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAI I AM T LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE TIAL PR T BACKFILL SEPTIC TANKS El
SIGNATURE SEEP PIT(s) ❑ CESSPOOLS❑
OF PERMI
JOHN A LAMBIE COUN ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK N O 1 CASH
�t�%9 1 4 0 4 4.5 0 ►�