HomeMy Public PortalAbout4904 FRATUS DR_Sewer__ a E-6D
S 63 11 55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING 6 ETELNO JOHN A LAMBIE COUNTY ENGINEERADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITYFOR APPLICANT TO FILL IN CROSS STLEGAL OWNER
DESCRIPTION LOT NO tMAIL
BLOCK TRACT ADDRESS NO OF BLDGSCITY rte
SIZE OF LOT NOW ON LOT
USE OF 7D1,CT GROUP MAP BUILDINGSi�--��
B PG
i
CONTRACTOR r J
ADDRESS , r ,�L ��rECONNECTION DATA
.W ,. ty + 5 �1 (J DEPTH
CITY � TEL NO p_S„[ �C� ERENCE UPPER
REGISTRATION NO�rs �/�C ❑ SAY /
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM ^]
HOUSE SEWER CONNECTING TO Y CURB L M L TO P L L
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD c@i $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD P C NO ^�
EXTN CESSPOOL,DRYWELL,MAN HOLE n $ 2 00 CO IMP NO r;6B�lib
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 c@i $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM tD $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE _
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I 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 Q
SIGNED THIS DAY F 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD - -
I 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
1 HEREBY CERTIFY THAT IAM 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 TH EGAL OWNER OF THE ABOVE
DESCRIBED RESIDE I L PROP BACKFILL SEPTIC TANKS D
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS[:j
OF PERMITTE
JOHN A LAMBIE COUN ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N 0 CASH
LAGo 9 13
0, JUN 11 4 4.5 0