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Home My Public Portal About5127 FARAGO AVE_Sewer__ D CE805 APPLICATION FOR PERMIT eeoe a Be COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDIN MBG r -2 JOHN A LAIE County Engmeer ADDRESS .L• CASSAT!D GRIFFIN Sup t of Buildmg LOCALITY .iG NEAREST � I y FOR APPLICANT TO FILL IN CROSS ST LEAL DESCRG TION LOT NO _OWNER MAIL BLOCK TRACT �.! ' ADDRESS NO OF BLDGS y� SIZE OF LOT NOW ON LOT CITY TEL NO / USE OF BUILDINGS � FMANALE MAP PROCESSED BY PQ CONTRACTOR ADDRESS % CONNECTION DATA CITY TEL NODEPTH STATE REGISTRATION NO H COUN6NO DESCRIPTION WOR FEE HOUSE SEWER CONNECTING TOPUBLICSEWER @ $3 00 SEPTIC TANK SEEPAGE PIT OR CTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3 00 P M L TOP L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 r HOUSE SEWER CONNECTING TOP C NO PRIVATE DISPOSAL SYSTEM 0 $1 00 CO IMP NO � JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER @ $1 00 SEWER OR DISPOSAL ABANDON YSTEM HOUSE $100 STATE PERMIT PERMIT NO _ INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE j REIMBURSEMENT FEE I ETO ' HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPES SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER SIGNED THIS nAY O 79_ NEW HOUSE SEWER AfP1 OWNER ORCONNECT 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❑ DRYWELL❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 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 I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN AL PROPERTY BACKFILL SEPTIC TANKS❑ _ SIGNATURE SEEP P (S) ❑ CESSPOOLS OF PERMITTE 12 ®► VALIDATION ROBERT WOOD pa p CA01; SUPERVISING MECHANICAL ENGINEER 4 1 c5aoae,as APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING ADDRESS JOHN IL LAMBIE County Engineer CASSATr D GRIFFIN Sup t of Building LOCALITY FOR APPLICANT TO FILL IN NEAREST ST LEGAL A S C DESCRIPTION LOT NO OWNER BLOCK TRACT y MAIL / 7 ADDRESSNO OF �Gt' SIZE OF LOT NOW ONLOTCITY TEL NO 47 - USE DI 1� DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS K PG CONTRACTOR ADDRESS �� CONNECTION DAT CITY TEL NO Z jj (j All' !? DEPTH 41 STATE ANHOLE REFERENCE a UPPER REGISTRATION NO COUNTY No DESCRIPTION OF WORK FEE L W HOUSE SEWER CONNECTING TO PUBLIC SEWER $3 00 SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM +] s7 GTS PITS AND/OR DRAINFIELD @ $H 00 Y CURB P L M L TOP 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 / 2T 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 ZJ CHARGES OWNERS+ PERMIT CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE ZI 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 CONNECT ADDITIONAL OWNERS AGENT— BUILDING OR WORK SEPTICTANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El 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 THT AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN PROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PITS ❑ CES POOLS Ll OF PERMITT4�� " ®r VAMATIO*-----� ROBERT A WOOD all me SUPERVISING MECHANICAL ENGINEER c