HomeMy Public PortalAbout4880 FRATUS DR_Sewer__ D
5&E 663 f 1.55 _ APPLICATION FOR PERMIT
S&E 8
DIVIS
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
F_OR APPLICANT TO FILL IN CROSS sT ✓ —
LEGAL OWNER
DESCRIPTION LOT NO '
MAIL ,
BLOCK TRACT 3 ADORES /�% ✓ '
NO OF BLDGS / CITY TEL NO
SIZE OF LOT NOW ON LOT J `
USE OF
BUILDINGS 'DISTRICT NO GROUP _ MAP
P
CONTRACTO _ a1"
ADDRESS/�� 1 - CONNECTION DATA A
CITY � TEL NO l� G 3V STATION T 3?, DEPTH �
MANHOLE REFERENCE PPER
STATE 6 REGISTRATION NO �` 613 �- �" Y-4 ❑❑ �,=Y LOWER
D=M=Y
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P 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,MAN HOLE @ $2 00 CO IMP NO Tf,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $100 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 @ $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE ` REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS DATE IN PECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING a
TO THE PUBLIC SEWER NEW HOUSE SEWER _.
SIGNED THIS DAY- F 19 , CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT r^
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOW EDGE 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 _
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND t
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE GAL OWNER OF THE ABOVE
DESCRIBED RESIDEN L PROP BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMIT
JOHN A LAMBIE COUNTY NG[NEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M 0 CASH
iso 9 1 2 8- ,1't!N 1 _ 4 4.5 0