HomeMy Public PortalAbout4877 FRATUS DR_Sewer__ D
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APPLICATION FOR PERMIT
5 8 E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE- DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
DDRESS f� _
A
JOHN A LAMBIE, COUNTY ENGINEER � � =
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS sT er
LEGALi coj OWNER ti
DESCRIPTION LOT NO / J
BLOCK TRACT P__'02-7 A)/
a'�' ADDRE S
NO OF BL CITY TEL NO i / Q�
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS —�� DISTRICT NO I GROUP MAP
P
CONTRACTOR �G V�� j C
CONNECTION DATA
ADDRESS ZL, 'LJ CU-S'P STATION 'T � '� O
/J n- _ 6 �� �� DEPTH
CITY Gv-�c.� TEL NO �� i
y A MANHOLE REFERENCE ] UPPER
/_7 7 L- ❑ci'O'ttMT�' I
REGISTRATION NO �+ �� �/ LWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO yycc TYPE OF CONNECTION�� LENGTH FROM +�
PUBLIC SEWER
@ $3 50 �V Y CURB M L TO P L �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
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 @ $100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL I
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 'J-70
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 DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT 49? SEPTIC TANK,SEEP, PIT(S) '
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLE GE THAT IHAVE READ THIS APPLICATION CESSPOOL[I DRYW ELL E:1AND 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 SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE-ABOVE
DESCRIBED RESIDENTIAL PROPE BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PIT(S) ❑ CESSPOOLS
OF PERMITTE
JOHN A LAMBIE, COUNT ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N 0 CASH '
1�, �9 1 2) 6 XN1�1. 4 4.50 �