HomeMy Public PortalAbout5318 FRATUS DR_Sewer__ S&E 663 12 54 APPLICATION,. FOR PERMIT
DIVISION OF BUII.DING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County Of LOS Angeles AD RESSG S /
WM.J FOX, COUNTY ENGINEER
CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER � L
BLOCK1-3 TRACT MAIL G rJ
ADDRESS �-
� NO OF BLDGS sJ
SIZE OF LOT '.!''p+'l! NOW ON LOT CITY TEL NO
USE OF
BUILDINGS "QQ h DISTRICT NN I GP I BK NAP
PG
CONTRACTOR .� L �O
ADDRESS -"Z4/—ya (.�/ ttCONNECTION DATA
CITY TEL NO STATION 7' � / DEPTH
❑ STATE 1 MANHOLEREFERENCE
REGISTRATION NO ❑ COUNTY 'MaWW LOWER
TYPE CTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Y CURB P L M L TOP L
LHOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IMP NO / / JOB NO ,
WORK TO HOUSE SEWER 1 00 F
ALTER OR REPAIR EXISTING M
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 CHAR ES
CONNECTION CHARGE FEE
OWNER'S PERMIT g t
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECT 1HEDATE AABOVE DESCRIBED EXISCTED WITH THE T(INGNAMED
DWELLIING CON APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC n,S.�EW//ER NEW HOUSE SEWER
SIGNED THISatOF 19� � �'� C Rl•,
OWNER OR _ A -" CONNECT ADDITIONAL
OWNERS AGENTE(J BUILDING OR WORK
ADDRESS q � SEPTIC TANK SEEP, PIT(S)
AND/OR DRAINFIELD
( 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
IHEREBY CERTIFY THAT 1 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 RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS 4 CA--
SIGNATURE y
OF PERMITTEE
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION
,BY j B8 1 9 ? SCP 2 1 4/
4.50
DEPUTY DEPUTY
BY BY rf//� /
,® DEPUTY T / I D PUTY