HomeMy Public PortalAbout4916 FRATUS DR_Sewer__ D
5&E 663 J 55
APPLICATION FOR PERMIT 1
8&E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING '/
WM.J. FOX, COUNTY ENGINEER ADDRESS C (�
CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY ITELNO
FOR APPLICANT TO FILL IN NEAREST
CROSS STLEGAL
DESCRIPTION LOT NO 3 OWN
BLOCK TRACT`/ MAIL
ADDRESSNO OF BLDGSSIZE OF LOT NOW ON LOT CITY
USE OF
BUILDINGS DISTRICT NO GROUP MAP
PG
CONTRACT- C � ,y a� 8R
ADDRESS CONNECTION DATA
CITY •TEL NO � STATION /-f-�Q
, DEPTH G
�M/ATE MANHOLE REFE(RENCEUPPER
REGISTRATION NO /�/ ❑ COUNTY -
NO DESCRIPTION Of WORK FEE
TYPE OF CONNECT LENGTH FROM 3r7..i
HOUSE SEWER CONNECTING TO Y CURB L M L TO P L oo�f
PUBLIC SEWER Q $-3-69
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR / P C NO
_ WORK TO HOUSE SEWEP 1 00 CO IMP NO 7 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
PERMIT CONNECTION CHARGE FEE
OWNER'S S 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE T OS CONNECTDATE -NTRTHEAABOVECTED WDESCRIBED EXISTINGITH THE HEREIN AMED DWELLING CON APPROVALS DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER ``//// s
SIGNED THIS OF 19- P
61It
OWNER OR -� CONNECT ADDITIONAL
OWNERS AG;NT BUILDING OR WORK
�
• SEPTIC TANK,SEEP, PIT(S)
ADDRES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
ALIFORNIA OR HAT I AM,. THE LEGAL OWNER OF THF, ABOVE ANDON HOUSE SEWER
Z-RES- 1 NTIA ROPERT I
IfACKFILL SEPTIC TANKS❑
.BEEP PIT(S) ❑ CESSPOOLS❑
OF PERM ITT
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R A WOOD, CHIEF PLBG. INSPECTOR
'4 C O ; 4 6 — leu', 4 1 0 n .0 0
_�ILa G 4 ;' /1 1 0 2.00 r