HomeMy Public PortalAbout5325 FRATUS DR_Sewer__ 6A642D 62
7APPLICATION FOR PERMIT
6A642 �J
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7
JOHN A LAMBIE County Engineer ADDRESS Y
WILLIAM A JENSEN, Sup t of Building
LOCALITY
NEAREST
FOR APPLI A T Tq FILL IN CROSS 5T Al P-1
LEGAL
DESCRIPTION LOT N OWNER
14 MAIL / /
BLOCK TRACT ADDRESS / ,Z
NO OF BLDGS ��/
SIZE OF LOT NOW ON LOT CIT TEL NO
USE OF DISTRICT N GROUP MAP PROCESSED BY
BUILDINGS BK PG
CONTRACT 1000,If Aff-
...�
ADDRESS CONNECTION DATA
I
CIT TEL N Zg 1/y STATION DEPTH
�j STATE MANHOLE REFERENCE
REGISTRATION NO f� ❑ COUNTY LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CO ON LENGT ROM
HOUSE SEWER CONNECTING TO Y URB P L M L TO L
PUBLIC SEWER @ SS 00 D O
SEPTIC TANK SEEPAGE PIT OR P 1 NO
NO
PITS AND/OR DRAINFIELD C S1000
CO IMP NO JOB
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO ^�
PRIVATE DISPOSAL SYSTEM @ $3 00 /
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $500
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING _
SEWER OR DISPOSAL SYSTEM S3 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT TI-(Fj-/CBOVE DESCRIBED EXISTING D WELLING
TO THE PUBLIC SE /jjLL// APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS AY OF 19
OWNER OR NEW HOUSE SEWER �f 4
OWNERS AGENM
1, CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP TION gND�OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE CCIMPLY
WITH ALL COUNTY
L ORDINANCES AND STATE LAWS RE UTING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I 7HE L GAL OWNER OF D INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOV DESLRI RESIDENTIIA P PERTY ABANDON HOUSE SEWER
SIGNATURE ` BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A WOOD
SUPERVISING MECHANICAL ENGINEER
CK M O CASH
2 iR 3 1_ 0 D 7.0(�