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Home My Public Portal About5021 FARAGO AVE_Sewer__ 7(iA 64Qb - Ct8E8 - 9/73 APPLICATION FOR PERMIT 10 'fl COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION B 021 Flara o Ave :,u= LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST GROSS ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT / ADDRESS Same 2 �jp OF SIZE OF LOT �)C 5-DW NOON LOTS CITY TEL NO "'� �5U 1 USE OF BUILDINGSres3.d DISTRICT NO GROUP SK MAP P 20CESSE BY /�'' I CONTRACTOR Universal Plumbing V/a4 Z ADDRESS 2631 Lee Ave CONNECTION DATA CITYO. EL NO STATION DEPTH LICENSE NO 16018 OLASSCj 6 STATE MANHOLE REFERENCE UPPER LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L PUBLIC SEWER 0 $7 00 SEPTIC TANK SEEPAGE PIT OR J C NO PITS AND/OR DRAINFIELD S1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT Y1 11 ■ 1 9111 T RECORD INSTR NO DATE } WORK TO HOUSE SEWER ® f 00 CL OVERFLOW SEEPAGE PIT DRAINFIELDr V EXTN CESSPOOL DRYWELL $S00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING � SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT y CD MANHOLEs7 00 PERMIT NO 9y W INDUSTRIALCL WASTE APPROVAL Z OWNER S PERMIT : 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR To APPROVALS CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL IJ BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 REGULATINGPLUMBING AND SEWERS CESSPOOL ❑ DRYWELL 1 HEREBY CERTIFY THAT M PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY S ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CAL FCRNIA OR THAT 1 AM E LEGAL OW R OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE D CRISED RESI L PROPERTY ABANDON HOUSE SEWER SIGNATURE r ACKFILL SEPTIC TANKS [3OF PERMITTEE SEEP PIT IS) ❑ CESSPOOLS ❑ VMMATION CK M O CASH VV if /P 7Z4--F3 CD 0 ro Q 0 0 IO 0 O O 01 a O ro -o 0 0l o p CH y c r 24650 INSERTS y 6AG42 6° 78A84YAPPLICATION FOR PERIVII t D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING .4 j6 BUILDING AND SAFETY DIVISION ADDRESS /T 10 PIMALAMCounty E er a.+ LLIAM A IENSEN Supt of uilding LOCALITY L• t NEAREST FOR APPLICANT TO FILL IN CROSS sr LEGAL 6' DESCRIPTION LOT NO OWNERlow pp, BLOCK TRACT MAIL ADDRESS ,& NtT OF BL �� CITY TEL NO SIZE OF LOT NOW ON LOTOT USE OF BUILDINGS DISTRICT NO GROUP BK MAP PG PROCES BY Og I CONTRACTOR � a / ADDRESS 5 ) ONNECTION DATA CITY TEL NO Q e,0 (,,d jr- TION DEPTH jj xj G STATE MANHOLE REFERENCE PPER REGISTRATION NO J-7.? / COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $S 00 TYPE OF CONNECTION LENGTH FROM / PITS ASEPTIC ND/OR DRAENFIELDT OR @ SS 00 Y CURB P L M L TO P L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ S2 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ 51 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT N W WORK TO HOUSE SEWER S1 00 V SEWER REPAIR R DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO O INDUSTRIAL V WASTE APPROVAL W CHARGES N OWNER S PERMIT 5 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE U—O REIMBURSEMENT FEE TRTHIS ONNECT IEIN NAMED I THE ABOVE ESCR BED EXSTING DWELLNG APPROVALS ACTOR TO CDATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER ORJ�� CONNECT ADDITIONAL OWNERSAGENT.LI_f BUILDING OR WORK ADDRESSSEPTIC TANK 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 ❑ 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 RESIDEfl PROPERTY BACKFILL SEPTIC TANKS ❑ S P PITS ❑ CESSPOOLS SIGNATURE Of OF PERMITTE ®� VALMATION—s, ROBERT A WOOD CL M D CASH/J SUPERVISING MECHANICAL ENGINEER L, C.)4 7 7 o" FfP 3 1 1 D 2500 M r * 24650 INSERTS CE1301re Go 7°A8420 APPLICATION FOR FERMI COUNTY COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSA 1 DEPARTMENT OF COUNTY ENGINEER BUILDING n $ A v BUILDING AND SAFETY DIVISION A ®SION ADDRESS r IOHN A LAMBIE County Encnneer WILLIAM A IENSEN Sup t of DwIdmg LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS Sr YAQ LEGAL DESCRIPTION LOT NO OWNER BLOCKMAIL TRACT ADDRESS ®� ftA A�0 NO OFBLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE DISTRICT NO GROUP MAP PROCES BY BUILDINGS CONTRACTOR �Qg HK � PG � ADDRESS j!j_ ONNECTIO1N DATA CITY TEL NO b LP 1-1 Cl O S ATION DEPTH d G, STATE MAN OLE REFERENCE P REGISTRATION NO -[ / COUNTY NO I DESCRIPTION OF WORK FEE /1 a HOUSE SEWER CONNECTING TO d, PUBLIC SEWER @ $8 00 TYPE 00 COECTION LENGTH FROM PITS AND/OR DRAINFGELDIT OR @ $e 00 Y CU B P L M L TO P OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ 52 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ $I 00 CO IMP NO JOB NO WORK C HOUSE SEWEBLDG OR @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO p INDUSTRIAL f+ WASTE APPROVAL CHARGES P.q OWNERS PERMIT $ 1 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE T ACTOR TO CIS DATE A CONTRACT WITH THE ONNECT THE ABOVE ESCR BED EXISTING NAMED APPROVALS NGDWELLIING DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER r SIGNED THIS DAY OF 19_ NEW HOUSE SEWER G (� OWNER /jam L�� CONNECT ADDITIONAL A OWNERS AGENT ""4-/r(� BUILDING OR WORK L 4 SEPTIC TANK SEEP PITS) AND/OR DRAINFIELD EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑LL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER REPAIR SEWER OR NG AND SEWERS SEWAGE DISPOSAL SYSTEM EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER NIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE BED RESIDEN 1 L PROPERTY SECKFILL SEjPI CANKS ❑LS ❑ URERMITTE Or VALIDATION ROBERT A WOOD CK. 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