HomeMy Public PortalAbout4921 FRATUS DR_Sewer__ E cCD
S& �3 I2 54 APPLICATION FOR PERMIT
5 E 1
DaVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM J FOX, COUNTMw, MY ENGINEER ADDRESS
CASSATT D GRIFFIN, 5
SUP T OF BUILDING LOCALITY /17
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
LEGALIlle� 7 'e� S �AA D OWNER
DESCRIPTION LOT NO
BLOCK TRACT MAIL '
pp .� ADDRESS
If v
SIZE OF LOT/00,Jr NOWOON LOTS
CITY TEL NO
USE OF
BUILDINGS !fi/ DISTRIC� I G I MAP
CONTRACTOR BK PG
ADDRESS !' NA CONNECTION DATA
CITY TEL NO STATION DEPTH
R., TATE MANHOLE REFERENCE
REGISTRATION NO /f// COUNTY UPPER LOWER
(� rX TYPE OF CONNECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Y CURB P L ML TO P L n
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO,
PRIVATE DISPOSAL SYSTEM 100 _
CO'4NECT ADDITIONAL BLDG OR CO IMP NO JOB NO
_ WORK 1`0 HOUSE SEWER 1 00 _
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AIJ D/OR DISPOSAL SYSTEM 1 00 PERMIT NO
_41 SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE 0t REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECT THE ABOVE WDESCR BEDITH THE H EXISTING NAMED
DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS_ DAY
NEW HOUSE SEWER
F_, —19_x= "- .��i��5 _•-��"�I—} _ o,.m.
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
-SEPTIC TANTS, E PITS)
ADDRESS D/OR,V7 FI L� 6 (O ll f
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
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 RESIDENTIA PROP Y BACKFILL SEPTIC TANKS❑
f SEEP PIT(S) [I CESSPOOLS❑
SIGNATURE
OF PERMIT TE a
WILLIAM J40X, COUNTY ENGINEER VALIDATION
_Co4376S M, 6 4 400 M
,BY BY .
DEPUTY DEPUTY
BY BY
® DEPUTY DEPUTY
T'
CESOB 12-°° APPLICATION FOR PERMIT
7eA eazD COUNTY OF LOS ANGELES SEWER-SEWAGE DIPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING All
JOHN A LAMBIE, COUNTY ENGINEER ADDREs
COLEMAN W JENKINS SUPT OF BUILDING
LOCALITY
NEAREST //�A
FOR APPLICANT TO FILL IN CROSS ST (f
LEGAL
DESCRIPTION LOT N _ OWNER L l
MAIL
BLOCK TRACT 7-73 L7 // ADDRESSNO (�S
SIZE OF e' NOWOON LOTS CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GR MAP PROCESSED BY
/ BK` PG
CONTRACTOR ` � + � y Jia
ADDRESS / ,�'J''" CONNECTION DATA
S F� TEL NO J v a 2 STATION 7 DEPTH I
STATE LIC /Y7� /J� MANHOLE REFERENCE UPPER
LICENSE NO CLASS
E (i
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIONLENG FROM
HOUSE SEWER CONNECTING TO Y CURB L M L P L
PUBLIC SEWER 55 00
SEPTIC TANK SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD S10 00 CO IMP NO `Ja'
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300 d
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER [ASEMEMT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300 U
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE $5 00 HWY OR ST WIDENING I,_
ALTER REPAIR OR ABANDON HOUSE C..)
SEWER OR DISPOSAL SYSTEM f3 00 STATE ENCROACHMENT LV
d
PERMIT NO Cn
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S z 00 CHARGES
AUTHORIZATION TOTAL FEE Z
CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WI H THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR T0.CO THE ABOVE DE [BED EXISTING DWELLING
TO THE PUBLIC 5 E �,�/y� APPROVALS DATE INSPE OR S SIGNATURE
SIGNED THI Y OF 191.E
OWNER OR ? NEW HOUSE SEWER 0 Z�
OWNERS AGE CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACK N LEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
AND STATE THAT E ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
LRESIDE
AND SEWERS CESSPOOL Cl DRYWELL ❑
Y CERTIF HA I M PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
AS REO IRE ANGLES COU N AND STATE OF SEWAGE DISPOSAL SYSTEM
A OR T AT I T L OWNER AND INTEND TO DISCONNECT PLUG AND
THE OVE CRIB TIA ROPE RTY ABAND N HOUSESEWERITTEE B IL T O
S P P
VALIDATION JACK R. ALL
M O CASH SUPERVISING MECHANICAL ENGINEER
nr_ 1 0 4 7r- JUN24 1 0 0 7.0 0�