HomeMy Public PortalAbout5131 FRATUS DR_Sewer__ C1E008 3 62^ J y V
76A642D �' APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FSSS
JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS SUP T OF BUILDINGINNFOR APPLICANT TO FILL IN _
LEGAL I /
DESCRIPTION LOT NO l OWNER
MAIL
BLOCK TRACT AljADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO `� V
USE OF DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS BK_ PG.
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL NO "" (f j7 STATION -1 .f DEPTH /fff000 oe
STAT LIC MANHOLE REFS ENCS UPPER
LICENSE NO CLASS ,� LO
NO DESCRIPTION OF WORK FEE TYPE OF ONNECTION L M L TO LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L7 d
PUBLIC SEWER @ $5 00 PC NO O
SEPTIC TANK SEEPAGE PIT OR V
CO IMP NO
PITS AND/OR DRAINFIELD @ $1000
HOUSE SEWER CONNECTING TO_ TRUNK PERMIT NO ROAD PERMIT NO O
PRIVATE DISPOSAL SYSTEM @ $3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT RECORD INSTR NO DATE I"
WORK TO HOUSE SEWER @ $300 W
OVERFLOW SEEPAGE PIT DRAINFIELD d
EXTN CES POOL DRYWELL MANHOLE @ 1 N
ALTER REPAIR OR ABANDON HOUSE HWV OR 5T WIDENING Z
SEWER OR SPOSAL SYSTEM @ $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL f
CHARGES
OWNERS PERMIT S 21, 00
AUTHORIZATION I TOTAL FEE loo CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTICTANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR A TE REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SE GE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM T ,LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN��_11�BOVECR18ED RSIIAL ROPERTY ABANDON HOUSE SEWER
SIGNATURE " BACKFILL SEPTIC TANKS ❑
OF PERM SEEP PIT(S) ❑ CESSPOOLS ❑
ALIDATION JACK R ALLEN
SUPERVISING MECHANICAL ENGINEER
CK M O CASH
9 G 7 0 o APR _0 D 5.0 0
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