HomeMy Public PortalAbout5018 FARAGO AVE_Sewer__ DEPARTMENT OF COUNTY "ENGINEER ' SEWER-SEWAGE DISPOSAL
DIVISION. ,OF_BUILDING AND SAFETY : PERMIT APPLICATION 34241
COUNTY OF LOS ANGELES I I BUILDING o ^
WILLIAM J. FOX, COUNTY ENGEE
INR i I ADDRESS.
FOR APPPLICAN O FILL IN L°cALfTY cTr
BUILDNG NEAREST
ADDRESS
D,( CROSSST. •,G� v
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST c A Y77 ts7
CROSS ST. ( ; RECEIVED BY Ready for Inspection DATE ISSUED
N
OWNER.
MAIL USE ZONE OCCUPANCY MAP'
ADDRES BK PG
CITY ` TEL.NO. POO
CONTRACTOR Calif ornia SeWer rnj0,at� 1 CO.IMP.NO.
ADDRESS '.,,13] x] ColerroyE AVA_ J N0.
CITY Montebello TEL.NOUNion _5n f TRUNK RMIT NO.
- STATE �
REGISTRATION NO. 1G444�J Vit,®iCSUNTY; ROAD PERMIT
LEGAL
DESCRIPTION LOT N0. (. STATE ENCROACH,MN�1_1 11010"
yy PERMIT NO.
BLOCK TRACT I�i� ���"./,,o�- f INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. i CHARGES
NOW ON LOT I
USE OF CONNECTION C RGE FEE
BUILDINGS .
NO. DESCRIPTION OF WORK FEE I
HOUSE SEWER CONNECTING TO REIMBURS ENT FEE
PUBLIC SEWER I ' , @ S 3.50 R IPT NO. I DATE ." I BY
HOUSE SEWER CONNECTING TO 4c
PRIVATE DISPOSAL SYSTEM 1.00. I D
CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED
WORK TO,HOUSESEWER`� 1.00' - N0. DATE I BY
ALTER OR REPAIR-EXISTING
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM. 1.00- -CONNECTION DATA
SEPTIC TANK',SEEPAGE PIT OR
PITS AND/OR;DRAINFIELD 2.00. STATION
f`T,oC7 DEPTH
CESSPOOL=DRYWELL
SPECIAL CONDITIONS ONLY 2.00 i �'! MANHOLE REFERENCE
UPPER
TYPE OF CONNECTION LENGTH.FROM p�—✓'
OWNERS PERMIT ; 1 . 00 464+13, P.L. M.L.TO'P.L. t/
AUTHORIZATION 'TOTAL_FEE
1 HAVE THIS DATE CONTRACTED WITH THE HERE N NAMED '
CONTRACTOR T0,CONNECT THE ABOVE DESCRIBED EXISTING ' APPROVALS INSPECTOR'S SIGNATURE' DATE
DWELLING TO THE PUBLIC SEWE �
SIGNED THIS....... _:DAY OF---w, 5.!:--- 19
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS T___ ..�.��,L {�/ BUILDING OR WORK
ADDRESS----_._- __--__ SEPTIC TANK;SEEP.PIT(S)
-• -•--- --• ---- AND/OR,DRAINFIELD
1 HEREDY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- "CESSPOOL I] DRYWELL
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
I HEREBY 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 D SCRIBED,R SIDENTIAL PROPERTY - BACKFILL SEPTIC TANKS I]
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE S s �" A
OF PERMITTEE_ 191 lAd
76A642A' 663 7/53J•/
JAY s
.. '1 .GI'tY'�/Ti' -1_:Pf. /M LS'-'1 C' R♦ ..
D'
CE808 a se - APPLICATION FOR PERMIT � 1
Eeoe COUNTY OF LOS ANGELES
SEWE R—SEWAC.v��_®I SPoSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 47NEAREST
DREISS 5018 IFIar$g0 St.JOHN A LFLMBIE, County FagmeesCASSATr D GRIFFIN, Sup t of Building CALITY Temple Clty
LCOR APPLICANTO FILL IN o3S ST Vy c
LEGAL
DESCRIPTION LOT NO OWNER -,Robert ZanYe-MAIL '
BLOCK' '� TRACT M� � � ��� ADDRESS 5018NO OF -Farago St.,, ' - `
SIZE OF LOT NOW ONLOT
S r CITYTempl-e C 1 ty TEL NO G 1 4-0177
USE OF -
BUILDINGS " DISTRICTNOGROUPBK MAP PG PROCESSED BY
L1
CONTRACTOR P8. Roberts �:7 ' M
ADDRESS' 21"85 No'- Fair Oaks Lve o : CONNECTION DATA
CITY Aatadena - , TEL NO Sy -4-44L STATION -�. }�` DEPTH- �
]`10079 c42 7� STATE MANHOLE REFERENCE , SUPPERS
REGISTRATION NO L] COUNTY
NO DESCRIPTION OF WORK FEE a,
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3 00 TYPE OF CONNECTION � LENGTH FROM r
SEPTIC TANK SEEPAGE PIT OR Y CURB P L) M L TO P L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD-
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO // ,I_ P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO GO til JOB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER @ $1 00 --+ TRUNK PERMIT NO " ROAD PERMIT NO
SEWER OR DISPOSAL SYSTEM HOUSE $1 00 STATE,'N OACHMENT BIZ AN +ate l 774
9
PERfifIT'NO A/ 7 C1 CEJ �/69
INDUSTRIAL
WASTE APPROVAL
CHARGES
4-OWNERS
PE $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE d REIMBURSEMENT FEE , r
r
I
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING- '
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL `7
OWNERS AGENT BUILDING OR WORK ^ (7
r SEPTIC TANK SEEP PIT(S)
ADDRESS 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 LOS ANGELES COUNTY AND, STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID L PROPERTYBACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS ❑
SIGNATURE 1
OF PERMITTE ,
F
Or VALIDATION ROBERTA WOOD_
1 aK h o CASH F SUPERVISING MECHANICAL.ENGINEER
1
1 ���o 8 1 5" jUL ' 1 j- v A 3 0 0`, �a.