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Home My Public Portal About5032, 5030 FARAGO AVE_Sewer__ DEPARIA ENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J FOX, COUNTY ENGINEER I ADDRESS �_O� � �� FOR APP A O FILL IN LOCALITY BUILDING NEAREST ADDRESS m CROSS ST LOCALITY DISTRICT NO SERIAL NO PERMIT NO ., AS NEAPEST CROSS ST �� A ^ RECE1 �Oeady for Inspection DATE TE ISS ED OWNER MAIL U ! ` OCCUPANCYI MAP ADDRESS "eBK PG CITY p� µ TEL NO CONTRACTOR C Noltingham Co of Temple Cltx CO IMP NO ADDRESS 5933 N CLOVERLY AVE JOB NO CITY TEMPLE fjTYjO ALIF TRUNK PERMIT NO STATE REGISTRATION NO COUNTY ROAD PERMIT NO LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO PERMIT NO BLOCKl/a USTRIAL TRACT � WASTE APPROVAL SIZE OF LOT0 OF BLDGS CHARGES NOW ON LOT USOF BUE DINGS �� CONNECTION CHARGE FEE N NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 350 RECEIPT NO I 17TE BY HOUSE SEWER CONNECTING TO / PRIVATE DISPOSAL SYSTEM 1 00 / CONNECT ADDITIONAL BLDG OR EXCEPTI RECORDED WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING NO I ATE I BY _SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1 00 CONNECTION\DATA SEPTIC_TANK SEEPAGE PITS AND/OR DRAINFIELDIT OR 200 _7� STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y CURB P L ML TO P L AUTHORIZATION I TOTAL FEE 0 P� t HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS DAY OF 19 _ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ _ _ _ _ _ _ _ BUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESS _ _ _ _ _ AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE f TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND / AND 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 RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS E] SIGNATURE M C No`fingham Co of Temple City SEEP PIT'S)❑ CESSPOOLS OF PERMITTEE _ _ _ _ 76A642A 663 7/53X(j? L _ A_42AA rte__ 78A E 669 11 SS 9 APPLICATION FOR PERMIT` 1 &E 88 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of LOS Angeles BUILDING ,79 JOHN A LAMBIE COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS sT LEGAL / � OWNER DESCRIPTION LOT NO ` MAIL BLOCK TRACT (� ADDRESS N 2 BLDGS - J CITY TEL NO SIZE OF LOT NOW N LOT !/ USE OF BUILDINGS DISTRICT NO I GROUP MAP BK PG CONTRACTO ADDRESSCONNECTION DATA I CITYSF 0 O STATION DEPTH TEL NO MANHOLE REFERENCE f TATE / LOW E REGISTRATION NO / elf ❑ COUNTY NO DESCRIPTION K FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FRO PUBLIC SEWER @ $3 50 Y CURB L M L TOP L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CONO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATEACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER S PERMIT S 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWE NEW HOUSE SEWER SIGNED THIS DAY OF —19'Cf CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK SEEP PIT(S) GG ADDRESS f� AND/OR DRAINFIELD" I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP Y 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 D!,%CONNECT PLUG AND LICENSED AS REOU ED BY 0 4TIGEL COUNTY STATNDON HOUSE SEWER C LIFO RNIA OR T AT E LE OWNER HE V D ED 1D IAP SEEP_FPIT(S) 0 CESSPOSEPTIC TANKSOLS❑ RMITTEE JOHN A LAMBIE COUNTY ENGINEER VALIDATIO ROBERT A WOOD C G 6PECTOR CK 61 0 CASH 679L, JUJ / 6 0 0 L',C0 �' 8 1 o A ro l �� -