HomeMy Public PortalAbout4914 FRATUS DR_Sewer__ C GOOD APPLICATION FOR 'PERMIT
eeoa•e-sa COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMBIE, County Fmgfneer ADDRESS
CASSAIT D. GRIFFIN, Su t of Buildin
P g LOCALITY
FOR APPLIC, /ANT TO FILL IN CROSS EST
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DESCRIPTION LOT NO OWNER %7 J'q L//_"a/v'o
BLOCK TRACT ;2�� AIL
Z r p DRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF _ /�F��ij /
BUILDINGS (�(/ /�/ DISTRICT NO GROUP MAP P OCESSED BY
BK PG
CONTRACTOR �-� t KC-6 0q d- �(
ADDRESS � /7 do CONNECTION DATA
CITY S S TEL N0� , STATION �'j -3 g DEPTH
REGISTRATION NO �. 7 G 4- STATE COUNTY MANHOLE REFERENCE C• UPPER
NO DESCRIPTION O WORK FEE �J LOWER
HOUSE SEWER CONNECTING TO Q
PUBLIC SEWER @ $3 00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y CURB P L M L TO P L
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER
SEWER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
OR DISPOSAL SYSTEM @ $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMEWS PERMIT $ 2 1 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE �T_j 0d REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSP CTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS SAY OF 19_ NEW HOUSE SEWER
OWNER OR // �/� CONNECT ADDITIONAL
OWNERS AGENT /V (-'--CAJ BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRY-WELL❑
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 GISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES C NTY AND STATE OF ABANDON HOUSE SEWER
CA RNI OR THAT 1 HE LEGAL NER HE yyISOVE
DU&IE RSIDENTIALL P ERTY. BACKFILL SEPTIC TANKS❑SI EEP PITS) ❑ CESSPOOLSIrTE
®� VALMATIO ROBERT A WOOD
CK H o CASH SUPERVISING MECHANICAL ENGINEER
Lt uJ`� is J a ;4U U 5.0
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