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Home My Public Portal About5332 FRATUS DR_Sewer__ 3,3,2- -61 76A6423-61 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 ,105i3 WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR P AN T IN CROSS ST. i LEGA OWNER DESCRIPTION LOT NO. [ MAIL BLOCK TRACT!V L ADDRESS VO.OF BLD GS' SIZE OF LOT NOW ON LOT CITY TEL NO USE BUILDINGS DISTRICT NO. GROUP MAP P CESSED BY W � r Lr BK PG CONTRACTOR ! ADDRESS !zC ^f �Yi ONNECTION bATA CITY TEL N0. S TION ✓ EPTH Y_' MANHOLE REFERENC `mss UPPER UNr REGISTRATION NO J� COTY No DESCRIPTI F _R FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ O FCO E LENGTH FROMSEP _ TS AND/ORTANK,SEEPAGIE @ S PIT OR 00 T. P.L. M L.TO P.L. P ' CJ OVERFLOW SEEPAGE PIT,DRAINPIELD f '( d EXTN CESSPOOL DRYWELL @ S 00 HOUSE SEWER CONNECTING TO P C NO. O PRIVATE DISPOSAL SYSTEM @ Et 00 CO IMP NO. JOB NO. U CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ S 00 TRUNK PERMIT NO ROAD PERMIT NO. ALT OR PAIRO R ABANDON SYSTEM HOUSE @ 00 STATE ENCROACHMENT O PERMIT NO U INDUSTRIAL W O_ WASTE APPROVAL N CHARGES ? OWNER'S PERMIT CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE IHAVE AT THIS DATE A CONTRACT WITH THE CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIJNGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. w� ' SIGNED THIS DAY OF 19- NEW HOUSE SEWER ., F.��A�k•'CLAi OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE-THAT I 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 SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDOWHOUSE SEWER CALIFORNIA OR THAT 1 AM THE AL OWPER OF THE ABOVE BACK ILL SEPTIC TANKS ❑ DESCRIBED RESID P P SIGNATURE SEEP PITS ❑ CESSP OLS OF PERMITTEE VALIDATION ROBFFRt A. WOOD cK M o. CASH SUPERVISING MECHANICAL ENGINEER 0 LAAO 1 6 DEC 14 1 1 D 2 5.0 0M ya ��W;�e (I _ CE8083 62 APPLICAT ON FOR PER IT 76A642D COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING�'2� JOHN A LAMBIE, County Engineer ADDRESS ,3 WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST OR PL NTT FI CRO55 ST LEGA DESCRIPTION LOT NO OWNER / MAIL BLOCK TRACT ADDRESS NO OF SLOGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAPPROCESSED BY BUILDINGS BK PG S_ CONTRACTOR � ADDRESS C NNECTION DATA '�7 Q� / ATION DEPTH CITY ! TEL NO lJ V REGISTRATION NO L T . ❑ COUNTY MANHOLE REFERENCE UPPER , NO DESCRIPTION OF WORK FEE TYPE OF CONNECT ' LENGTH FROM aeHOUSE SEWER CONNECTING TO Y , CU P L ML TO P L O PUBLIC SEWER @ S5 00 " / PC NO SEPTIC TANK SEEPAGE PIT OR JOB NO V PITS AND/OR DRAINFIELD $100 CO IMP NO I HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT / ^� PRIVATE DISPOSAL SYSTEM @ S30 / CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER [ASEME NT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ S500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACHMENT PERMIT NO INDU TRIAL W AS'E APPROVAL OWNERS PERMIT $ 2 00 R E AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE,DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE A SIGNED THIS DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGENT_ 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 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS' REGULATING PLUMBING AND SEWERS . CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND ID BOV DESURIBED RESIDENTI PROPERT RESE IN T ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH Lf .o s It W DEC 14 1 () D 7.0 0'