HomeMy Public PortalAbout5320 FRATUS DR_Sewer__ -61
7BA642D APPLICATION FOR PERMIT
76A 642
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A JENSEN Sup t of Building_ LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS Sr
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT / MAIL
ADDRESS
SIZE OF LOT O /S` NO OF BL
DGS NOW ONLOT
CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUg,
� MAP PROCESSED BY
CONTRACTOR BK PG/ G
ADDRESS L CONNECTIIONIJ ATA
CITYL NO L� STATION � 4- 51 DEPTH
REGISTRATION NO COUNTY MANHOLE REF R C LOWER
No I DESCRIPTION OF _WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $S 00 TYPE OF CONNECT!ON LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR YOB P L L T P L
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ 52 00 42v&o }
a
HOUSE SEWER CONNECTING TO P C 0 O
PRIVATE DISPOSAL SYSTEM @ SI 00 CO 4XV6 JOB NO tJ
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ S1 00 d'
SEWER OR DISPOSAL SYSTEM ABANDON HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL Y.I
WASTE APPROVAL
N
CHARGES Z
OVv RAS PERMIT 3 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
DATE A CONTRACY WITH THE HEEIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER / Ain
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER �
OWNERS AGENT
BUOW ER OR ILDING ING ORNECT DWORKAL
ADDRESS SEPTIC TANK SEEP PlT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTE
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER `
CALIFORNIA OR THAT 1 AM THE LE OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDEN L PR ERTY. SEEP PITS ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
MATION ROBERT A WOOD
cK. r 0 CASH SUPERVISING MECHANICAL ENGINEER
LAUG
5 7�0 3 � DEC 5 1 -O 0 3.00