HomeMy Public PortalAbout5329 FRATUS DR_Sewer__ r
C6A642D62 APPLICATION FOR PERMIT
7A642D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ZB
LDING
JOHN A LAMBIE, County Engineer RESScz
f
WILLIAM A. JENSEN, Sup't of Building )
ALITY
REST
FOR APPLICANT TO FILL INSB BT
LEGAL
DESCRIPTION LOT NO �D� (� OWNER
MAIL
BLOCK TRACT A ADDRESS
NO
SIZE OF LOT-'5'9'4 NOWOON LOTS CITY TEL NO
USE OF DISTRICT N13 GROUP MAP, PROCE ,ED BY
BUILDINGS
�-+ — BK PG r
CONTRACTOR G us�S'C e ,Y!/ � 0 I o
ADDRESS /�� �7 /c t' S T CONNECTION DATA
CITY ,5"l
TEL NO �'��'0 / STATION DEPTH
❑ STATE UPPER
REGISTRATION NO ❑ COUNTY MANHOL REFERENCE LOWER
NO DESCRIPTION OF WORK FEE TYPE O ONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y RB P L M L TO P L -
PUBLIC SEWER @ $5 00
SEPTIC TANK SEEPAGE PIT OR P C NO V
PITS AND/OR DRAINFIELD C $1000 CO IMP.NO .10B�O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO R PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAWER EASEMENT ECORD INSTR N DATE
WORK TO HOUSE SEWER $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $500 N
AySSArAgPA}R�OR ABANDON HOUSE HWY OR ST WID INC
S4AWa.GR DISPOSAL SYSTEM @ $3 00 00 STATE ENCROA HMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
AUTHORIZATION I TOTAL FEE 6-0 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 SEW�E.,R,� _ _�� APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19L4//''.7
OWNER OR NEW HOUSE SEWER
OWNERS AGEN'1�v Tom, Lam'" —7J--� CONNECT ADDITIONAL
BUILDING OR WORK -
ADDRESS
SEPTIC TANK 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
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 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECTPLUG AND
RESIDE IN THE ABOVE DESI_RIBED RESIDENTIAL PROPERTY ABANDON HOUSESEWER
SIGNATURE
OF PERMITTE BACKFILL SEPTIC�TANKS ❑ �, .dr� //!P
SEEP PIT(S) Q CESSPOOL ® �/
VALIDATION ROBERT-A WOOD
' cK M D CASH SUPERVISING MECHANICAL ENGINEER
LAC0 9 6 1 71 ,SAN 1- 5 10 ,D 5.0 0-
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