HomeMy Public PortalAbout4885 FRATUS DR_Sewer__ E 6D
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APPLICATION FOR PERMIT 1
S E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING Z►�
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY h� G
FOR APPLICANT TO FILL IN CROSS ST
LEGAL I` OWNER
DESCRIPTION LOT NO (�
BLOCK TRACTMAIL
ADDRESS 2J��—���
NO OF BLDGS67
/•dam
SIZE OF LOT NOW ON LOT CITY r- TEL NO' K
USE OF
BUILDINGS O �� DISTRICT NO GROUP MAP
PG
CONTRACTOR C� � .�-�f7^ 45— s
ADDRESS �� /tqf CONNECTION DATA -
C� STATION / �i DEPTH
CITY -C/ TEL NO /G`/' (D PPER
MANHOLE REFERENCE
❑ STATE
REGISTRATION NO
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
PUBLIC SEWER @ $ 3 50 ) Y CURB L l 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 �3G�-A44
HOUSE SEWER CONNECTING TO r
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 @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ t 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSVECTOR 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 SEPTIC TANK SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLE GE 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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF
DISCONNECT ABANDON HO PLUG PLUGUSE AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTIAL PRPPtV7YBACKFILL SEPTIC TANKS ElSIGNATURE
SEEP PIT(S) ❑ CESSPOOLS ElF PERMIT E `
JOHN A LAMBIE COUN ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N 0 CASH
Lt,CO 9 1 3 4. JUli 11 4 4.5 0 9,