HomeMy Public PortalAbout5328 FRATUS DR_Sewer__ 76AS420 APPLICATION- FOR ■ Eo MI ■
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDIN
ADORES G (Cp 04 '
WM.J. FOX, COUNTY ENGINEERt "
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS r
LEGAL ��JJ I
DESCRIPTION LOT NO ZVI_ OWNER
BLOCK TRACT /r 4/ MAIL "
/� -/ ADDRESS K✓L�L.4..
SIZE OF LOT L% � o OONBLOTS � CITY `�'rl,, TEL'NO -33
�3? �t >�
BUILDINGS / )�� tea, L i
DISTRICT GROUP MAP
f BK PG
CONTRACTOR / � L /0 91
ADDRESS _ -CC C,�Z+1 CONNECTION DATA
CITY +yl,y , TEL NO • X STATION ���� t� DEPTH
STATE MANHOLE REFERENCE �j�t �/ 8R
REGISTRATI NO Ja' I/ t COUNTY
J J�
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE 0 ECTION LENGTH FROM Hyl O
PUBLIC SEWER @ $ 3 50 Y CUR P L ML TO P L _Q
HOUSE SEWER CONNECTING TO
,PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR �� J �j P C NO
WORT( TO HOUSE SEWER 1 00 __CO IMP NO JOB NO
ALTER OR REPAIR EXISTING'
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO1{j60101.?j'
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFICLD 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
$
OWNER'S
PERMIT CONNECTION CHARGE FEE
� o0
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INS ECTOR•S SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER 1
SIGNED THIS _DAY OF rte' �- 19�
CONNECT ADDITIONAL I
OWNER OR �l � /]�+���LS J � BUILDING OR WORK
OWNERS AGENT -r/I•
ADDRESS L
`� SEPTIC TANK,SEEP, PIT(S)
'�'•�� t-_� / AND/OR DRAINFICLD
I HEREBY ACKNOWLEDGE THAT 1 AVE R AD THIS AaLICATION CESSPOOL[IDRYWELL❑
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 1 AM PROPERLY CISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES C NTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE L_;AL NER OF THC ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIA ROPERTY. 'BACKFILL SEPTIC TANKS❑ // ` p 11 /J/�
� SEEP. PIT(S) ❑ CESSPOOLS S'C+ W(5`4 � ,. (�C�6�--
SIGNATURE
OF PERMITTE
WILLIAM J.FOX,C TY ENGINEER VALIDATION- R.A.WOOD, CHIEF PLBG. INSPECTOR
1.ACO6 6 1, 7° JUM 2 4 cj.5 {7 In
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