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Home My Public Portal About5004 FARAGO AVE_Sewer__ CE808 °° I: APPLICATION FOR PERMIT 1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUDILDING r-A� �� ✓� JOHN A LAMBIE COUNTY ENGINEER ADRESS COLEMAN W JENKINS SUP T OF BUILDING �r/� LOCALITY V NEAREST FOR APPLICANT TO FILL IN CROSS 6T AaW 414- LEGAL / r DESCRIPTION LOT NO OWNER G.. / MAIL BLOCK TRACT ADDRESS NO OF BLDGS ' SIZE OF LOT NOW ON LOT CIT �iTEL NO USE OF DISTRICT NO LDINGS GROUP MAP PG PROCESSED BY BUI CONTRACTOR J' g .L 4K ADDRESS CONNECTION DATA i CITY TEL NO STATION 1-13 �7 DEPTH / l> I STATE LIC ` UPP R LICENSE NO CLASS MANHOLE REFERENCE /7'/ /tj D OWE NO DESCRIPTI N OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB L ML TOP L PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD .10 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM @ $300 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIY[■ EASEMENT RECORD INSTR NO DATE V WORK TO HOUSE SEWER @ $ 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 f'- AI.FER-RCPATR9R ABANDON HOUSE HWY OR ST WIDENING W SA"Vew.9�i DISPOSAL SYSTEM @ .3 00 �D D STATE ENCROACHMENT d PERMIT NO fn INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s i 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLICSEW APPROVALS DATE INSP CTOR S SIGNATURE SIGNED THIS DAY OF 19,0 OWNER ORNEW HOUSE SEWER OWNERS AGENT "tzvCONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) 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 LICENSEDAS REQUIRED BY LOS ANGLES C TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OW OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE AB DESCRIB REST AL PROPERTY ABANDON HOUSE SEWER SIGNATURE ElOF PERMITTEE BACKFILL SEPTIC TANKS7e SEEP PIT(S) ❑ CESSPOOLS VALIDATION JACK R AL EN CK M O CASH SUPERVISING MECHANICAL ENGINEER J tOf` 3 9 -9 0- IiI �' 1pD 5.00"' CEAOB 1268 Taa aa2� ` APPLICATION FOR PERMIT ® COUNTY OF LOS ANGELES SEWER rdV®AGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING }— JOHN A LAMBIE COUNTY ENGINEER ADDRESS `DC7 /'e /?)9 G d COLEMAN W JENKINS SUP T OF BUILDING LOCALITY / NEAREST FOR APPLICANT TO FILL IN CROSS ST '< LEGAL �9 �7 n�l/� ,! JBY DESCRIPTION LOT NO OWNER YyG Z�/.7 �C/7'V'✓ r��V MAIL BLOCK TRACT s2 �J ADDRE�^SS/� Z /� � ,VIV�C �SIZE OF LOT NOWNO O0NLOTB CITYVwNNOUSE OF BUILDINGS �' DISTRICT NO GROUP MAP PG PRCONTRACTOR 0 `, �I� N�1 h -c C6V- � � � H ADDRESS 'JL Z ,E VR1 L e 1�1 VIS CONNECTION DATA CITYSi9"6�f,�2J�L TEL NO 2 le-0 �9 ai STATION -{ DEPTH 1 STATE �1 G^/ r CLASS ASL / MANHOLE REFERENCE ✓ LOWER® LICENSE NO /S Vj NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR M HOUSE SEWER CONNECTING TO `� Y CURB P L ML TO P L PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ f1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO r PRIVATE DISPOSAL SYSTEM @ $300 O_ CONNECT ADDITIONAL BLDG OR AFFIDAVIT wMYE. EASEMENT RECORD INSTR NO DATE � `Z WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE $S 00 CD HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE C„) SEWER OR DISPOSAL SYSTEM @ f3 00 W STATE ENCROACHMENT c- PERMIT NO C/) INDUSTRIAL WASTE APPROVAL CHARGES [1,11NEWNERS PERMIT S 2 00 CONNECTION CHARGE FEE HORIZATION TOTAL FEE VE AT THIS DATE A CONTRACT WITH THE HEREIN ED CON REIMBURSEMENT FEE TOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS HE PUBLIC SEWER DATE INSPECTOR S SIGNATURE ED THIS DAY OFOWNER OR 19_ ERS AGENT_ NEW HOUSE SEWER CONNECT ADDITIONAL C� ESS BUILDING OR WORK /' A SEPTIC TANK SEEP PIT(S) EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL COUNTYORDINANCES AND STATE LAWS REGULATINGBING AND SEWERS CESSPOOL ❑ DRYWELL EREBY CERTIFY THAT PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR NSED AS REQUIRED ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM FORNIA OR THAT i E LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND DE Mln. i'Btf DESCRIBED RESIDENTIAL OPE ABANDON HOUSE SEWER ATUREPER EE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION JACK R ALLEN ci M O CASH SUPERVISING MECHANICAL ENGINEER pr^ 5 5 5 4CR JM25 1 0 0 13.00-