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Home My Public Portal About5102 FARAGO AVE_Sewer__ 6A565 76A64565 APPLICATION FOR PERMIT S4 CC7UNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING )011\ A LANIBII County 1 ngmPPr ADDRESS ��G1 N j^ C 01 F NIA 11 JF\hlV' Sup t of Building LOCAL TV e �� / �7�� NEAREST FOR APPLICANT TO FILL IN CROSS S7 LEGAL DESCRIPTION LOT NO OWNER r / n MAIL BLOCK /'� TRACT f ADDRESS Al NO OF BL GS {� SIZE OF LOT NOW ON LOT CITY � 1 TEL NO 7 � ��Q USE OF DISTRICT NO GROUP MAP PROCES D B BUILDINGS L lam. C K �G CONTRACTORwr ADDRESS CONNECTION DATA CITY TEL NO STATION �! �I DEPTH LICENSE LICENSE UPPER NO l CLASS MANHOLE REFERENCE -5, / 0 NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER 0 $ 5 00 PC NO d SEPTIA K SEEPAGE PIT OR PITS AND/OR DRAINFIELD C $10 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V PRIVATE DISPOSAL SYSTEM C $ 3 00 CONNECT ADDIT I ON A L�tC1t 1110 /� AFFIDAVIT [WA11IVEASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER C $ 3 00 1A 'ALTER REPAIR OR ABANDON HOUSE (� SEWER OR DISPOSAL SYSTFM C $ 3 00 HWY OR ST WIDENING d h EX7N CESSPOOL MANI OLE <' $ 0 STATE ENCROACHMENT z PERCOLATION TEST G PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT E 2 00 CHARGES AUTHORIZATION TOTAL FEE � CONNECTION CHARGE FEE ' A 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEW ER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ 0CKALIDATION M 0 CASH � �� 0 6 4 24 1 D 500- 82 APPLICATION ION OR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILD ING JOHN A LAMBIE County Engineer DDRESS WILLIAM A JENSEN Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS 5T " LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK jo TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF 1' BUILDINGS DISTRICT NO I GROUPI MAP PG PROCESSED BY CONTRACTOR / {I/ly-�1/,• L� ADDRESS CONNECTION DATA STATION / DEPTH Y CI EL NO / STATE (,,, UPPER MANHOLE REFERENCE REGISTRATION NO 7,0/ � COUNTY , I^•"^^ NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO �� Y CURB L M L TO P L PUBLIC SEWER @ SS 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND DRAINFIELD il0 00 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NOw ROAD PERMIT NO a. PRIVATE DISPOSAL SYSTEM 53 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVIR I rASEMEMT RECORD INSTR NO DATE WORK TO HOUSE SEWER $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s z 00 CHARGES AUTHORIZATION TOTAL FEE /J CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH_ THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DES IBED EXISTING DWELLING TO THE PUBLIC SPYE159 APPROVALS DATE INSPECTOR 5 SIGNATURE SIGNED THIS DAY OF OWNER ORNEW HOUSE SEWER `71TL" OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL [I DRYWELL ❑ 1 HEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT THE GAL OWNER OF D INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABO DESCR D R IDENTIAL OPERTY ABANDON HOUSE SEWER SIGNATURE C BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT IS) L] CESSPOOLS ❑ VALIDATI ROBERT A WOOD CK M 0 CASH SUPERVISING MECHANICAL ENGINEER