HomeMy Public PortalAbout4870 FRATUS DR_Sewer__ D
S&E663 11-55 APPLICATION FOR PERMIT 1
S @ E 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engmeer m
County of Los Angeles BUILDINGCA
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JOHN A LAMBIE, COUNTY ENGINEER _ADDRESS / C/ 4
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY c_ "
FOR APPLICANT TO FILL IN CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO v '
MAIL
BLOCK TRACT / ADDR S
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF �, Q
BUILDINGS DISTRICT NO GROUP MAP
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CONTRACTOR 'IS" - / BK Ps—
ADDRES � 2.Lf . �c � - CNE[fONCTION DATA 1G_
CITY TEL NO STATION �"�" / DEPTH
J MANHOLE REFERENCE UPPER
REGISTRATION NO / (, ��'— O
STATE
—Y' EFt
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y CURB L j M L TOP L
PUBLIC SEWER @ $3 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 ti6�B•�J$. � �..�. 1 -
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 @ $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE _
OWNER'S PERMIT $ t o0
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I 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 Z S
SIGNED THISDq 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) '
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1HAVE 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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN AL PROP ` BACKFILL SEPTIC TANKS❑
SIGNATURE (J SEEP PITS) ❑ CESSPOOLS❑
OF PERMIT
JOHN A LAMBIE COU ,Y ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK N 0 CASH
LAIN9 1 2 65- J U M 11 4 4 .5 0