HomeMy Public PortalAbout5337 FRATUS DR_Sewer__ -8,
76A642D APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TNEAREST.
ILDING ,
JOHN A, LAMBIE, County Engineer DRESS
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WILLIAM A. JENSEN, Sup't of Building_ CALITY
fFOR APPLICANT TO FML IN OSS ST
LEGAL OWNER
DESCRIPTION LOT NO
Oro
BLOCK TRACT MAIL
ADDRESS o-
N OF BLDGS. , J
SIZE OF LOT NOW ON LOT CITY TEL N I
USE OF
iv I-
BUILDINGS A DISTRICT NO GROUPMAP PR ESSED BY
CONTRACTOR ]"' I HK P6 /
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ADDRESS {j
, CONNECTION DATA71
CI TEL N0. STATION _ DEPTH'
STATE MANHOLE REFERENCE
" REGISTRATION NO COUNTY = I
No I DESCRIPTI N OF Wulilk FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION -LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y CURB P LJ M L.TO P.L. .�
PITS AND/OR DRAINFIELD @ SS 00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRYWELL @ 32 00 d
HOUSE SEWER CONNECTING TO P C NO. O
PRIVATE DISPOSAL SYSTEM @ E1 00 CO IMP NO JOB NO. V
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT N0.
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ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 { PERMIT NO U
Y INDUSTRIAL Lu
- WASTE APPROVAL
H
CHARGES Z
OWMRIS PST S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAKED CON-
TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAL$ ,DATE INS�ECTOA:S,SIGNATURE
TO THE PUBLIC SEWER. '�L�� ��yy
SIGNED THIS DAY OF 19- - NEW HOUSE SEWER N I .,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADORESIFVV SEPTIC TANK SEEP,PIT(S)
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 pLTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTE
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESI TIAL P OP Y BACKFILL SEPTIC TANKS ❑ Ej
SIGNATURE SEEP PITS ❑ CESSPOOLS
OF PERMITI
VALmATIOROBERT A. WOOD
CK. d.o, CASK SUPERVISING MECHANICAL ENGINEER
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