HomeMy Public PortalAbout4903 FRATUS DR_Sewer__ E6D
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APPLICATION FOR PERMIT
S E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer � �j •�
County of Los Angeles BUILDIADDRESSG 7� 7e�'cT�-e
JOHN A LAMBIE, COUNTY ENGINEER ��
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST -�-+-
LEGAL OWNER 17,
DESCRIPTION LOT NO
MAIL
BLOCK TRACT ` A DRE ��y �'1S{�l-�/C/�lit�✓WJ / n
NO OF BL / CITY . . TEL NO'Z_/ 1,
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS a� DISTRICT NO GROUP MAP
PG
CONTRACTO c
1 -- CONNECTION DATA
ADDRESS
�/-� STATION �(py DEPTH
CITY `�-� TEL NO
MANHOLE REFERENCE /'' PPER
STATE
11,
REGISTRATION NO
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM C
HOUSE SEWER CONNECTING TOY CURB P L' M L TOP L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO JOB NO -2——24
EXTN CESSPOOL,DRYWELL,MANHOLE n $2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM c+ $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 $ 1 00 2
REIMBURSEMENT FEE I
AUTHORIZATION TOTAL FEE IAf-6
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INS ECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING A
TO THE PUBLIC SEWER NEW HOUSE SEWER �fwv—
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL l
OWNER OR BUILDING OR WORK
OWNERS AGENT_ I� 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
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 PROPERT BACKFILL SEPTIC TANKS❑
SIGNATURE ' SEEP PITS) [_1CESSPOOLS❑
OF PERMITTEE"
JOHN A LAMBIE, COUN ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK N O CASH -
9 1 3 3 JUN 11 - 4 4.5 4