HomeMy Public PortalAbout4871 FRATUS DR_Sewer__ ED
5&6-669 I1 55 APPLICATION FOR PERMIT
3& -8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY ✓. c
s
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
j
BLOCK TRACT �J�t `��C.� ADDRE
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
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PG
CONTRACTOR ,3- K
c
CONNECTION DATA
ADDRESS
STATION DEPTH 6 �
CITY t� TEL NO
MANHOLE REFERENCE 11111 KFfPER
REGISTRATION NO L t/3- 7 ❑ STATE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
TYPE OF CONNECTION LENGTH FROM
Y CURB M L TO P L rl
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO y /,
EXTN CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO � in. N^ 2�
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 c+ $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM a $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSP CTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER l^1
SIGNED THIS D , F 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD-
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL ElAND STATE TH4T 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
IICHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS GELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THA; 1 AM L GAL OWNER OF THE ABOVE
DESCRIBED RESID P BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERM
JOHN A LAMBIE NTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N O CASH
ks'.n,o 9 1 3 ?, M1 "11 4 4.50 1)