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Home My Public Portal About5016 FARAGO AVE_Sewer__ } 24650 INSERTSCEO O42D 76A6APPLICATION, FOR PEFiMITN.,--,1 f8A42D COUNTY OF LOS ANGELES - SEWER-SEWAGE DISPOSAL_` DEPARTMENT,OF COUNTY ENGINEER- BUILDING BUILDING AND SAFETY�D nSION ADDRESS LAIEI k A JENSENCSup t of Bu ld ng LOCALITY WI �� a y t NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL Ir DESCRIPTION LOT NO' 10 DOWNER ti , MAIL � BLOCK TRACT -7 IAA'L 929 NO OFBLDGS "-2 ` - T SIZE OF LOT NOW ON LOT CITY TEL NO ` USE OF DISTRICT N GROUP'' MAP" - -PROCESSED BY BUILDINGS _ BK PG CONTRACTORAf ADDRESS / � J/ CONNECTION CITY L TEL NO/_, A G O S A ON ! DEPTH STATEMANHOLE REFERENCE PPER ' REGISTRATION NO /� % COUNTY No DESCRIPTION OF WORK 'r F E HOUSE SEWER CONNECTING TO SD PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TOP L PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO ' P C NO _ PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO �. CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO 0 s WORK TO HOUSE SEWER @ $1 00 i SEWER REPAIR R ABANDON SYSTEM HOUSE @ $1 00 - STATE ENCROACHMENT PERMIT NO O r INDUSTRIAL U WASTE APPROVAL W CHARGES OWNER'S PERMIT $ 22 00' CONNECTION CHARGE FEE AUTHORIZATION- TOTAL FEE �_ OV REIMBURSEMENT FEE - ! HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR"S SIGNATURE TO THE PUBLIC SEWER ' SIGNED THIS DAY OF - 19= NEW HOUSE SEWER OWNER OR -- p CONNECT ADDITIONAL- - - OWNERS AGENT / , . _ BUILDING OR WORK - ADDRESS SEPTICTANK 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 ❑ r`,' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS - , ' SEWAGE DISPOSAL SYSTEM - - I 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 RESIDENT AL ROPERTY _ BACKFILL SEPTIC TANKS ❑ + SIGNATURE _ SEEP PIT(S) ❑ CESSPOOLS [:3 _ - OF PERMITTEE , OF ri VALIDATIO ROBERT A WOOD - _ CK M 0 CAsx' SUPERVISING MECHANICAL ENGINEER Y Y _ 0 5. 3 '1 AUG 11 G U_0 51, t��' ' � �, Y 24650 INSERTS �a� �✓ `� 76666660 - APPLICATION FOR PERBV61, 76A642D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL "y z DEPARTMENT OF COUNTY ENGINEER q BUILDING AND SAFETY DIVISION ADDRE SBUILDING _ JOHN A LAN31E County Eaggsneer WILLIAM A JENSEN, Sup t of Buildmg LOCALITY ' NEAREST n' � FOR APPLICANT TO FILL IN r CROSS ST - LEGAL?- RIPTIO OWNER f DESCRIPTION LOT NO IN ' BLOCK TRACT ADDRESS NO OF LDGS + SIZE,OF LOT NOW ON LOT V CITY —� TEL NO Ip USE DI a� DISTRICT NO GROUPJ_ ` MAP PROCESS BY BUILDINGS /� `� BK PG CONTRACTOR ('y J G(1 ADDRESS r '— -CONNECTION D TA CITY TEL No/L D "(P�_1 (p 4 ION � DEPTH REGISTRATION NO `'' COUSTATNTY MANHOLE REFERENCE_ -� -� NO DESCRIPTION OF WORK FEE ' HOUSE SEWER CONNECTING TO t �O PUBLIC SEWER @ $3 00 1 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR ' Y CURB P L M L TO P L ITS AND/OR DRAINFIELD @ $3 00 R OVERFLOW SEEPAGE PIT DRAINFIELD , EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO S JOB NO y� CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO U WORK TO HOUSE SEWER @ St 00 SEWER RR REPAIR R ABANDON HOUSE @ $i 00 STATE ENCROACHMENT p� + PERMIT NO Q INDUSTRIAL M WASTE APPROVAL 'W CHARGES - L� OWNERS -PERMIT $ QNN im CONNECTION CHARGE FEE AUTHORIZATION -TOTAL FEE - (1!! REIMBURSEMENT FEE - -} 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON _ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S^SIGNATURE TO THE PUBLIC SEWER fi SIGNED THIS DAY O 19_ NEW HOUSE SEWER ' OWNER ORS' `a � s CONNECT ADDITIONAL OWNERS AGENTj`-'✓/ BUILDING OR WORK ADDRESS _ SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I HEREBY:ACKNOWLEDGE-THAT I HAVE READ,THIS-APPLICATION, ,- I . -_ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ElDRYWELL'❑ WITH ALL COUNTY ORDINANCES"AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND,SEWERS I I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR' SEWAGE DISPOSAL SYSTEM _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND ABANDON HOUSE SEWER CALIFORNIA OR,THAT 1 AM THE LEGAL 'OWNER OF THE ABOVE - - DESCRIBED RESIDE I `L PROPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE- SEEP PIT(S) P CESSPOOLS ❑ OF PERMITTEE ., ®P , VALID, IO ROBERT A WOOD W CK m 0 cases SUPERVISING MECHANICAL ENGINEER, CAlk"'�- z32 404 itv 1011 D 25G ()`�.a C78 AE808 IS 68 , APPLICATION FOR PERMIT A COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FC.D.. ILDING JOHN A LAMBIE, COUNTY ENGINEER DRESS P/f COLEMAN W JENKINS SUP T OF BUILDING ALITY REST FOR APPLICANT TO FML IN sT & vv d LEGAL DESCRIPTION LOT NO 09 OWNER MAIL BLOCK TRACT ` ( ADDRESS NO OF BLD06 SIZE OF LOT NOW ON LOT CITY C, TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP ROCESS D yr 8 PG CONTRACTOR ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH I STATE LICMANHOLE REFERENCE / UPPER LICENSE NO CLASS LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER f5 00 SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD $1000 CO IMP NO JOB NO ' HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO r PRIVATE DISPOSAL SYSTEM @ $300 0— I CONNECT ADDITIONAL BLDG ORC) % AFFIDAVIT WAIVER [ws[HENT RECORD INSTR NO DATE C� (/ WORK TO HOUSE SEWER 0 $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE 5500 O� ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING C) SEWER OR DISPOSAL SYSTEM $3 00 LLj STATE ENCROACHMENT O_ PERMIT NO Cn INDUSTRIAL Z WASTE APPROVAL CHARGES LRCSIDE WNERS PERMIT S z Oo HORIZATION TOTAL FEE CONNECTION CHARGE FEE VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TOR TO,CONNECT THE ABOVE DESCRIBED EXISTING DWELLING_ HE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE NED THIS DAY OF 19_ ER OR NEW HOUSE SEWER ERS AGENT_ CONNECT ADDITIONAL RESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ BING AND SEWERS CESSPOOL ❑ DRYWELL EREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR NSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM FORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND DE IN THE AB E DESCRIBED RESIDENTIAL PROPERTY gBANDON HOUSE SEWER ATURE PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION JACK R ALLEN CK M O CASH`^ SUPERVISING MECHANICAL ENGINEER 0'0 8 1-1 I:fit 4 1 D 5.00- 4