HomeMy Public PortalAbout4861 FRATUS DR_Sewer__ „
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5&E669 If-55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles pDoaEssG '7,J (v
JOHN A LAMBIE, COUNTY ENGINEER
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS S l
LEGAL
DESCRIPTION LOT NO / �j OWNERMAIL
l
BLOCK TRACT ' r.� 07 �'_�J ADDRESNO OF
SIZE OF LOT NOW ON�LOT BLDGS CITY TEL NO ` �.,
USE OF
BUILDINGS DISTRICT NO V GROUP MAAPPBK PG
., C
CONTRACTOR t ��/ _7T_
CONNECTION DATA
ADDRESS,,&/,-
CITY C(, j TEL NO ` `�� STATION ` DEPTH
° MANHOLE REFERENCE /47 PPER
STATE k.Lawn
REGISTRATION NO l( ' /� + ❑��q'Y
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3
HOUSE SEWER CONNECTING TO Y CURB M
50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO
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
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INShPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING h
TO THE PUBLIC SEWER NEW HOUSE SEWER 111 tic
SIGNED THIS DAY F 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT J SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGPEE 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 HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL R OF THE ABOVE ,
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑
SIGNATURE i SEEP PIT(S) ❑ CESSPOOLS El
OF PERMITT -
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JOHN A LAMBIE COUNTY ENGIN R VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK N 0 CASH
LhCo 9 1 3 9) JJII 11 4 4.5 D in