HomeMy Public PortalAbout4913 FRATUS DR_Sewer__ D
s&E660 9 SS APPLICATION FOR PERMIPERMIT8 Bi E 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST �
LEGAL
DESCRIPTION LOT NO c�? OWNER a44 ,
MAIL
BLOCK TRACT a�`7 ADDRESS f
/ ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS )ISTRICT NO I GROUPI MAP
G �r � BK PG
CONTRALTO ��
ADDRESS I CONNECTION DATA
CITY TEL NO STATION DEPTH
STATE MANHOLE REfERENCE 3,1/ UPPER
REGISTRATION NO / 7� ❑ COUNTY
_
NO DESCRIPTION F WORTK FEE
TYPE OF CONNECTI LENGTH FROM r
I'OUSE SEWER CONNECTING TO Y CURB ( P"L J M L TO P L
PUBLIC SEWER Q S�
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR / P C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO ( JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
OWNER'S $ o0
PERMIT CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE � REIMBURSEMENT FEE
TRACTORHAVE T OS CONNECTDATE ONTRTHEA ABOVECTED WDESCR BED EXISTINGITH THE HEREIN AMED D`NELLI APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS A OF 19 NEW HOUSE SEWER
OWNER OR / CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
// o SEPTIC TANK,SEEP PIT(S)
ADDRE�S AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL E3 DRYWELL[3AND 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 TH T I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS A GELES COUNTY AND STATE F DISCONNECT PLUG AND
CA�1 RN1A OR THAT AM THEfLEGA OWNER O E A 'E A NDON HOUSE SEWER
DESCR /ARES NTI Y. CKFILL SEPTIC TANKS❑
SIGN URE/ I EEP PITS) ❑ CESSPOOLS 0
OF PERhYI TEE _ le47 -
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG INSPECTOR