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Home My Public Portal About5126 FARAGO AVE_Sewer__ I TEMPLE CITY 89 CESOB APPLICATION FOR PERMIT E808 8 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A LAMBIE CountF Ea eer f CASSAIT D GRIFFIN Supt of Su.1 LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNE BLOCK TRACT M AK D S 0 OFBLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAPP C SSED BK PG CONTRACTOR ADD ESS CGHNECTION bATA CIT L NO WTr ON DEPTH STATE MANHOLE REFERENC REGISTP4TIO1100NO oelleCOUNTY (► No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 -20 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ $100 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER @ S1 00 ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNEl#S PERMIT CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 67D REIMBURSEMENT FEE HAVE AT TRACTOR TO CIONNECT TH S DATE AON BOY T ESCRIBED EXISTIHE ING DWELLNAMED ING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRY-WELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND CE LINSED AS REQUIREDY LOS ANGE OUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT/FNTHE L 0 ER OF THE ABOVE DESCRIBED RESIDENT L P OPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE SE PIT(S) ❑ CESS 00 [IOF PERMITTE �ATION ROBERT A WOOD E � to G CASH SUPERVISING MECHANICAL ENGINEER 878 :51S110v172500 �1 TEMPLE CITY D CE808 r APPLICATION FOR PERMIT eeoe a se COUNTY OF LOS ANGELES SEWER- GE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A LAMBIE County EnTneor CA33ATT D GRIFFIN Supt of Building LOCALI NEAREST FOR APPLICANT TO FILL ceoss sr LEGAL OWNER DESCRIPTION LOT NO BLOCK TRACT A L DDR S N6 OF BLDG SIZE OF LOT NOW ON LOT Y TEL NO USE OF BUILDINGS DISTRICT NO I GROUP MAP PROLE ED BY BK PG �� CONTRACTOR O AD L" ,¢[ CONNECTION DATA CI L NO S A ON DEPTH . PPE STATE MANHOLE fjCE REGISTRATION NO COUNTY No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER@ $3 00 ® TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT N WORK TO HOUSE SEWER @ $1 00 ALTER OR DASPOS L SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE I HAVE AT THIS DATE CT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT HE ABO DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEW SIGNED THIS DAY 19_ NEW HOUSE SEWER // ►1 .®m('s�- - OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRY-WELL El 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 DISCONNECT PLUG AND LICENSED AS REQUIRED B OS ANGELES C AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I M THE LEG NER THE ABOVE DESCRIBED RESIDENTI PRO ERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP PITS ❑ CESSPOOLS OF PERMITTE ®' 'AUDAffON ROBERT A WOOD Ca m o CASH SUPERVISING MECHANICAL, ENGINEER L}o$ 7s � � rnr �7 i� 0 50th M