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Home My Public Portal About5125 FARAGO AVE_Sewer__ t 3 7088 CE8E808 8 APPLICATION FOR PERMIT 1 �8 COUNTY OF,LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER },7 /� BUILDING AND SAFETY DIVISION BUIADDRESS d� / JOHN A LAMBIE County Engmees CASSATT D GRIFFIN Sup t ofTBu2ldmg LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER BLOCK TRACT MAIL /ADDRESS �J10*NO OF BL GS ;- �j SIZE OF LOT NOW ON LOT CITY c-� TEL NO USE OFWE BUILDINGS DI NO G:iiL,,- K MAP PG PROCESSED BY CONTRACTOR -� -5- ADDRESS � 7— CONNECTION DATA CITY A TEL NO/_ j!�9 &A 4Z -3` DEPTH -�� REGISTRATION NO !j� G B STATE 04HOLE R ERERCE UPPER f� COUNTY LOWER NO DESCRIPTION OF WORK EE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $S 00 Y CURB P L M L TO P L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE Q $2 00 HOUSE SEWER CONNECTING TOP C NO PRIVATE DISPOSAL SYSTEM $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER $1 00 ALTER REPAIR OR ABANDONHOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM $1 00 PERMIT NO INDUSTRIAL WASTE APPROVAL G! CHARGES OWNER S PMWT $ _ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE - —,00 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 SIGNED THIS DAY OF 19— NEW HOUSE SEWER - - OWNER OR /1� CONNECT ADDITIONAL OWNERS AGENT if-27 BUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 1S 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 HOUSETSEWER ^ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI ROPERTY BACKFILL SEPTIC TANKS❑ SEEP PTS CESSPOOLS[ISIGNATURE �rj�/7/�� OF PERMITTE 14 - n ®r YALIDATIOC -, ROBERT A WOOD SUPERVISING fdfiCHAN1CA1,fiNG1NfifiR 1 `'�7 3l�b f a 'v �eAaasm� 7GAi42 Be APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DMSION BUILDING pT JOHN A LAMBIE County Engineer ADDRESS �G— CASSATT D GRIFFIN Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER r/� V 4• �I' BLOCK TRACTMAIL AD ESS O NO OFBLDGS SIZE OF LOT NOW ON LOT CITY TEL NO BUILDINGS USE DISTRICT NO GROUP MAP PROCESSED BY PG CONTRACTOR - ADDRESS j' CONNECTION DAT CITY TEL NO/ r DEPTH i REGISTRATION NO O ` e STATE M N OLE REFERENCE _ R COUNTY LOWER NO I DESCRIPTION OF WORK F E HOUSE SEWER TO LIER@ $3 00 SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM / PITS AND/OR DRAINFIELD 0 $3 00 Y CURB PL M L TO P L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM Q $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO 6 WORK TO HOUSE SEWER @ $1 00 ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM 1 00 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERM $ 2]_00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT S DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INS�ECT611 S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTICTANK SEEP PIT(S) ADDRES4 AND/OR DRAINFIELD I 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 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE TIAL PROPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP T(S) ❑ CESSPOOLS❑ OF PERMITTE ®r VALIDATION ROBERT A WOOD » pa, r p (�R SUPSRV181N8 MECHANICAL ENGINEER 4