HomeMy Public PortalAbout5019 FARAGO AVE_Sewer__ 6D
S&963 f2 54 APPLICATION FOR PERMIT 7
5 8 E 6 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer //}}
County of Los Angeles BUILDIN
SG (�I
WM J FOX COUNTY ENGINEER
CASSATT D GRIFFIN SUP t of BUILDING LOCALITY Adl 7,
FOR APPLICANT TO FILL IN CROSS ST f%Jt'P_ !�i7 - 9C` A INIP
LEGAL
DESCRIPTION LOT NO OW OWNER j 7
BLOCK N TRACT /, 7 MAIL
ADDRESS Se, )QjNO'OF
LZN�.
SIZE OF LOT r NOW ON LOTS CITY ?> iTuN l �3
USE OF
BUILDINGS DISTRICT NO GR MAP
CONTRACTOR I BK PG
I
ADDRESS CONNECTION DATA ,G
CITY EL STATION IC I � G DEPTH
,t ❑ STATE ��.G S 6-1 MA UPPER REFERENCE
REGISTRATION N ❑ COUNTY
TYPE OF CONN TLON,� LENGTH FROM
NO DESCRIPTION OF WORK
/--
E Y CURB (( P L ML TO P L J
LHOUSE SEWER CONNECTING TO l
PUBLIC SEWER Q $ 3 50 3 Vo
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO IMP NO / 3 JOB NO
_ WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
_ SFWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER TATE ENCROACHMENT
AND/OR DI.,POSAL SYSTEM 1 00 PERIIIT NO
SEPTIC TANK SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARG.�
PERMIT CONNECTION CHARGE FEE/
OWNER S s 1 00 ENT
AUTHORIZATION I TOTAL FEE fU FEIMBURSEM
TRACVORHAE TTO CONNE THIS DATE ONTRTHEAABOVECTED WDESCR BEDITH THE HEXISTINGADWELLIING CON APPROVALS DATE INSPECTOR S SIGNlTURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19- NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT IP.Jr BUILDING OR WORK
ADDRESS EPTIC TANK SEFP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAMS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SnWERS SEWAGE DISPOSAL SYSTEM
I HER BY 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 1 AM THE LEGAL OWNER OF THE A VE y !-
DSCRIBED RESIDENTIAL PROPERTY /� i- BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J FOX COUNTY ENGINEER VALIDATION
sT ...LD3B6 9 419 MAY 13 4 450 �
DEPUTY �t DEPUTY
8T By
® DEPUTY DEPUTY