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Home My Public Portal About5005 FARAGO AVE_Sewer__ 1°_82 76A,642D APPLICATION FOR PERMIT' 8A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS / WILLIAM A JENSEN Sup t of Building LOCALITY ;4- FBLOCNEAREST FOR APPLICANT TO FILL IN CROSS 57 K A ON LOT NO [+ OWNER )� MAIL TRACT ADDRESS NO OF BLDGS OT NOWON LOT CITY TEL NO TRICT NO GROUP MAP P CESSED BBK PG CONTRACTOR/4q �/� a Q L' ADDRESS ,7 /1,i►.t..�.. .�,� CONNECTION DATA CITY `� TEL NO S STATION /I$ L DEPTH t` 2 9 " LJ COUNTY"I*F�211 STATE MANHOLE REFERENCE P2 REGISTRATION NOI NO DESCRIPTION-OF WORK FEE TYPE OF CONNECTION ENGTH FROM d HOUSE SEWER CONNECTING TO Y CURBL M L TO P L O PUBLIC SEWER @ $5 00 S O V C NO SEPTIC TANK SEEPAGE PIT OR J CO IMP NO OB NO PITS AND/OR DRAINFIELD @ $1000 � HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM @ $3 00 V CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE t1A WORK TO HOUSE SEWER @ $300 0- OVERFLOW OVERFLOW SEEPAGE PIT DRAINFIELD h EXTN CESSPOOL DRYWELL MANHOLE @ $500 b ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM $300 I STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE /�0 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 PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THI A F i9_ GG TT EE OWNER OR NEW HOUSE SEWER OWNERS AGE CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PITS) 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 ❑ 1 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 M THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE AS V DESCRIBE SIDENTIAL PROPERTY ABANDON HOUSE SEWER / n SIOF APERMITTEE ` BACKFILL SEPTIC TANKS ❑ SEEP PITS) ❑ CESSPOOL$ VALIDATION ROBERVA WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH �j n,n LJ11'vt3 7 rJ JUL �) / .li C„ w DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES _ WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS QOJ y Qi�� FOR APPLICANT TO FILL IN LOCALITY_p� BUILDING 0 a NEAREST ADDRESS f/V �YJZF 11 �✓i CROSS ST LOCALITY d DISTRICT NO SERIAL NO PERMIT NO - C NEAREST P qj �—, A CROSS ST I RECEIVED BY Ready for Inspection DATE ISSUED OWNER � / MAIL / USE ZONE OCCUPANCY MAP ADDRESS „ fJ`e ?� I I I BK PG CITY TEL.NO. �+ / CONTRACTOR M. C. Nnttingham CO d Temple City CO IMP NO ADDRESS 5933 N CLOVERLY AVE. JOB.NO CITY TEMPLf> gd% CALIF. &per /� ❑ TRUNK PERMIT NO REGISTRATION NO C % '7 O COUNTY ROAD PERMIT NO LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO PERMIT NO BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO OF BLDGS CHARGES NOW ON LOT USE OF BUILDINGS CONNECTION CHARGE FEE NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER @ $ 350 RECEIPT NO DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1 00 NO ALTER OR REPAIR EXISTING DATE BY SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 100---, CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 200 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 d e MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM Y CURB PL ML TOPL OWNERS PERMIT $ I 1 00 1 AUTHORIZATION I TOTAL FEE IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS DAY OF __ _ _ 19__ _I NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ _ _ _ _ _ _ _ _ BUILDING OR WORK SEPTIC TANK,SEEP PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELLEl CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ER OF THE ABOVE DESCRIBED RESIDE TIAL PROPERTY BACKFILL SEPTIC TANKS /f SEEP PIT(S)E3 CESSPOOLS SIGNATURE t / , OF PERMITTE ` 76A642A 663 7/53 _ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0609120003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID SEWER / SEPTIC SEWER BUILDING ADDRESS TR 11497 LT 16 BL A EXIST OCC GRP 5005 FARAGO AV BLDGS NOW ON LOT TEMP CA 917803526 ASSESSOR INFORMATION NUMBER CONNECTION TYPE NEAREST CROSS STREET GRAND 8574-008-017 ORIGINATION THOMAS PAGE 597 GRID D4 LOCALITY TEMPLE CITY C LENGTH ML TO PL STATION DEPTH TENANT MANHOLE REFERENCE UPPER/LOWER ISSUED ON PROCESSED BY EXPIRES ON 09/19/06 JK 03/18/07 COUNTY IMPROVEMENT NUMBER OWNER TEL NO PLAN CHECK NUMBER FINA AT FI Y CODE WU CHRISTINA CHIUNG HWA VIVIAN YA-L (818) 991-0132- JOB NUMBER 5005 FARAGO AV TRUNK PERMIT NUMBER TEMP 917803526 ROAD PERMIT NUMBER D SCRI TION OF WORK AFFADAVIT NO ALTERATION OF HOUSE SEWER WAIVER NO APPLICANT TEL NO EASEMENT NO WU (818) 991-0132- 5005 FARAGO AV RECORD INSTRUMENT NBR RECORD DATE SPECIAL CONDITIONS TEMPLE CITY CA 91780 HIGHWAY/STREET WIDENING STATE ENCROACHMENT PERMIT NUMBER CONTRACTOR TEL NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE LUMINA DESIGN & CONSTRUCTION, INC (626) 388-3331- 6908 N VISTA ST LIC NO FEE DESCRIPTION QUANTITY UOM AMOUNT NE?, HOUSE SEWER SAN GABRIEL CA 91776 751894 B 01 PERMIT ISSUANCE FEE 27 75 CONNECT ADDITIONAL 13 WORK TO HOUSE SEWER 1 00 EAC 30 45 BUILDING OR WORK ARCHITECT OR ENGINEER TEL NO TOTAL FEES 58 20 - SEPTIC TANK SEEPAGE PIT LIC NO AND/OR DRAIN FIELD DRYWELL SEWER MAP BOOK PAGE ALTER, REPAIR, SEWER OR SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS _ SEEP PIT CESSPOOL GRAYWATER SYSTEM REPORT ID DPR266 ROUTE TO BS0508