HomeMy Public PortalAbout4867 FRATUS DR_Sewer__ D
ISaE689 11 55 APPLICATION FOR PERMIT 1
S&E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING //p J �7,
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS �7J lt� / �1—a
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST ,� O
LEGAL
DESCRIPTION LOT NO OWNER % �> ,
MAIL /f
BLOCK TRACT ` ADDRES
NO OF BLDGS CITY TEL NO � `
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP MAP
BUILDINGS B PG
CONTRACTOR �� �'` `_pa L , �l � - �?Ste_
ADDRESS ,i" / Q CONNECTION DATA
CITY ����i TEL NO STATION �Q DEPTH
/ MANHOLE REFERENCE R
REGISTRATION NO /��'C— ❑ STATE LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTI LENGTH FROM
' HOUSE SEWER CONNECTING TO c'7 Y CURB P L j M L TO P L
PUBLIC SEWER @ $3 50 .J
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 Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 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 OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY AC40WL GE 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 HOUSE SEW
CALIFORNIA OR THAT I AM TH EGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTI PROP Y BACKFILL SEPTIC TANKS❑
SIGNATURE ^ SEEP PIT(S) ElCESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COU Y ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK M O CASH
L1PO 9 1 3 8 ; J0 11 4 4.5 0 4`'