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HomeMy Public PortalAbout5104 FARAGO AVE_Sewer__ PERMIT APPLICATION F 76A8 2D l COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS !��/ r T^ 2C C COLEMAN W JENKINS SUP T OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL /! t��, •r - DESCRIPTION LOT NO / OWNER vG� MAIL BLOCK TRACT ADDRESS Nb OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS f�� DISTRICT NO GROUP MAP z ESS ED BY BK PG CONTRACTOR I C(8� 1 �„� / ` ADDRESS Ati CONNECTION DATA `­ STATION 2 2 DEPTH CITY EL NO 1 STATELIC i UPPER LICENSE NO CLASS MANHOLE REFERENCE 7'�� 77 NO DESCRIPTION O WORK FEE TYPE OF CONNECTION J LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P M L TO P L �- PUBLIC SEWER @ E5 00 O SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO � JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 O CONNECT ADDITIONAL BLDG RAFFIDAVIT WAIVER 1ASIM11T RECORD INSTR NO DATE WORK TO HOUSE SEWER S3 00V -OVERFLOW SEEPAGE PIT DR INFIELD W EXTN CESSPOOLDRYWELL MANHOLE @ S5 00 / d ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEWER OR DISPOSAL SYSTEM S300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s AUTHORIZATION TOTAL FEE CHARGES CONNECTION CHARGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO COV NECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER A OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(5) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNI,.pOS E LEG 2ZL DISCONNECT PLUG AND RESIDE IN IB ESABANDON HOUSE SEWER SIGNATURE B ❑ OF PERM BACKFILL SEPTIC TANKS ji SEEP PIT IS) El CESSPOOLS ❑ ALIDATION JACK R ALLEN SUPERVISING MECHANICAL ENGINEER CK M O CASH 5 9 1 r OCT 6 1 1 3.5 0 A-13 ©v(? COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0705160004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID ISEWER / SEPTIC SEPTIC BUILDING ADDRESS ITR 11497 LT 11 BL B 1EXIST OCC GRP 5104 FARAGO AV IBLDGS NOW ON LOT TEMP CA 917803527 ASSESSOR INFORMATION NUMBER lCONNECTION TYPE NEAREST CROSS STREET FREER 18574 009 032 JORIGINATION THOMAS PAGE 597 GRID D4 LOCALITY TEMPLE CITY Cl ILENGTH ML TO PL STATION DEPTH ITENANT IMANHOLE REFERENCE UPPER/LOWER 11SSUEL ON PROCESSED BY EXPIRES ON 1 I 1 105/16/07 JK 11/12/07 1 ICOUNTY IMPROVEMENT NUMBER I I (OWNER TEL NO IPLAN CHECK NUMBER IF NAL DAT BY CODE I 1PIRAINO JOHN DOROTEA (626) 444 4112- IJOB NUMBER I 1 15102 FARAGO AV ITRUNK PERMIT NUMBER II ITEMP 917803527 IROAD PERMIT NUMBER IDESCRIDTION OF WORK 1 IAFFADAVIT NO IDISCONNECT SEPTIC SYSTE 1 1 1WAIVER NO 1 I (APPLICANT TEL NO (EASEMENT NO I I IRUDY S PLUMBING (626) 358 1490 1 1 1 1900 S PRIMROSE AVE 1RECORD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS I IMOROVIA CA 91016 HIGHWAY/STREET WIDENING 1 1 I ISTATE ENCROACHMENT PERMIT NUMBER I I I ) I ICONTRACTOR TEL NO FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1 IRUDY S PLUMBING (626) 358 1490 1 1 1 1900 S PRIMROSE AVE LIC NO FEE DESCRIPTION QUANTITY UOM AMOUNT INEW HOUSE SEWER I I I IMONROVIA CA 91016 784580 C36 I 1 1-1 1 1 i01 PERMIT ISSUANCE FEE 27 75 ICONNECT ADDITIONAL I I 1 I 29 DISCON/ABANDN SEPTIC 1 00 SYS 30 45 IBUILDING OR WORK 1 I 1 (ARCHITECT OR ENGINEER TEL NO I TOTAL FEES 58 20 1 1 I 1 1 1 ISEPTIC TANK SEEPAGE PITI I 1 1 LIC NO I (AND/051 DRAIN FIELD I I 1 IDRYWEIL 1 SEWER MAP BOOK PAGE 1ALTER REPAIR SEWER OR I I I 1 1 ISEWAGE DISPOSAL SYSTEM 1 1 1 1 _I IDISCOINECT PLUG AND I I 1 1 IABAND(N HOUSE SEWER I I I I I I BACKFILL SEPTIC TANKS I I 1SEEP PIT _ CESSPOOL _1 l ,•_9y _ r I IGRAYWATER SYSTEM 1 I 1 I I I I I I I I I I I I 1 I I I I I 1 I I I I I i 1 I I I I I I I I I I REPORT ID DPR266 ROUTE TO BS0508 1 1 1 1 1 I I I I I