HomeMy Public PortalAbout5123 FARAGO AVE_Sewer__ /S
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CE808APPLICATION FOR PERMIT,
c>soe s Be COUMff OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
ADDRESS
JOHN A LANIBIE County'Fmgmeer
CASSATT D GRIFFIN Supt of Budci=g LOCALITY C
NEAREST
EGA Z
PLICANT TO IN CROSS ST
C�7
DESO OWNER J
BLOG MAIL
ADDRESS
NO 0 BLDGS
SIZENOW ON LOT CITY TEL NO
USEBUI � DISTRICT NO GROUP MAP PROCESSED BY
PG
CONADDCONNECTION DATA
CITYTEL NO ,f_ 1,,.e'b-' STATION , � DEPTH
STATE
REGISTRATION NO ".3, G B COUNTFMANHOLE ERENCE UNo DESCRIPTION OF W RK FEE L WER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00SEPTIC TANK SEEPAGE PIT OR CONNECTIO LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 CURB P L M L TOP L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRY-WELL MANHOLE @ $200
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM $1 00 CO IMP NO %-V JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER Q $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT 2 OO CONNECTION' CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS -DATE INSPECTOR S SIGNATURE
TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER (�,7
SIGNED THIS OF f9_ NEW HOUSE SEWER
OWNER CONNECT ADDITIONAL f
OWNERS AGENT - BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 4CESSPOOL❑ DRYWELL[Il
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 TH T I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE I PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS ❑ CESSPOOLS
OF PERMITTE
Olt VALMATIOU,--, ROBERT A WOOD
Rt: ■ q C/1E!( SUFKRVISING MECHANICAL ENGINEER
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