HomeMy Public PortalAbout5333 FRATUS DR_Sewer__ F
-61
76A6423-61
APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 3
JOHN A, LAMBIE, County Enggineer ADDRESS
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEAL
DESCRIGPTLON LOT NO jOWNERti ALOt-4
BLOCK TRACT MAIL
ADDRESS
0.OF BLDGS. /
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OFDI DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS
CONTRACTO Ll HK P6
1-4
'�'�
ADDRESS CONNECTION ATA
CI TEL NO STATION - DEPTH
REGISTRATION NO L� COUNTY STATE MANHOLE REFERENIf C !J UPPER
No. DESCRIPTION OF R FEE 7
1
PUBLIC SEWER f9 0 i TYPE OF ONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR dY. } CURB P.L. M.L.TO P L.
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P C NO. O
PRIVATE DISPOSAL SYSTEM @ St 00 CO IMP NO JOB NO. U
CONNECT ADDITIONAL BLDG.OR �� TRUNK PERMIT NO. ERMIT NO.
WORK TO HOUSE SEWER St 00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACH MEN Q
SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO U
W
INDUSTRIA p„
1 WASTE ABPROVAL N
CHARGES z
OWNER'S PERMIT g 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE "IrREIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- a I'
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORjS;SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY 711 NEW HOUSE SEWER
OWNERS AGE CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS— SEPTIC TANK,SEEP.PITS) >'
AND/OR DRAINFIELD
I 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 OS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T T I A T LEGAL CALIFORNIA OR T T I A T LEGAL OW"R OF THE ABOVE
THE ABOVE
DESCRIBED RESID IAL PR E /' BACKFILL SEPTIC TANKS ❑
SIGNATURE 1 SEEP PITS ❑ CESSPOOLS
OF PERMITTE
VALMATIOI ----� ROBE=RT A. WOOD
c16 r o. CASH�J SUPERVISING MECHANICAL ENGINEER
LA r:3 0 4 6 9 11PR 4 1 0 0 3 .0 0