HomeMy Public PortalAbout4874 FRATUS DR_Sewer__ D
S&E-663 11 95 APPLICATION FOR PERMIT 1
S&E•8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer n
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST c -<
LEGAL Z�
DESCRIPTION LOT NO OWNER
MAIL
�s �
BLOCK TRACT -1 ADDRESS
NO OF BLDGS CITY TEL NO d�
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS .�-`L� DISTRICT NO G 0 1` MAP
s� BK PG
CONTRACTORn `, 6 S
ADDRESS CONNECTION DATA
„�
TEL NO
CITY / � STATION r DEPTH r
MANHOLE REFERENCE UPPER
STATEREGISTRATION NO � �G/�'�` � - ❑( (/ ER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
+ PUBLIC SEWER @ g 3 SO � Y CURB AL / M L TO P L
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 '^�.r' .v L��.,Z
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $100 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"
OWNER'S PERMIT g t 00
AUTHORIZATION TOTAL FEE 6--<--
--C REIMBURSEMENT FEE
1 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 CJ'�
SIGNED THIS F CONNECT ADDITIONAL
OWNER OR ) BUILDING OR WORK
OWNERS AGENT v, -� SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
DISCONNECT
DON HOUSE SEWER PLUG AN
CALIFORNIA OR THAT I AM THE LEGAL 0 THE ABOVE
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑
SIGNATURE /
SEEP PIT(S) LlCESSPOOLS❑
OF PERMITTE � � N,
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK m0
CASH
LAC=E 9 1 2 7 1 JIM 11 4 4.50