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Home My Public Portal About5132 FARAGO AVE_Sewer__ _ TEMPLE CITY d' CE808 B 89 APPLICATION FOR PERMIT EBOB 7 COUNTY OF LOS ANGELES SEWER—SK±!n DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A LAMBIE County Engineer CASSATf D GRIFFIN Sup t of Building LOCALI NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER BLOCK TRACT MAR S AOD NO OFBLDGS SIZE OF LOT NOW ON LOT f C Y TEL NO USE OF " BUILDINGS DISTRICT NO GROUP MAP PROCES DB BK PG I CONTRACTOt ADD CO CTION DATA CIT NO ION DEPTH ❑ STATE MANHOLE F R.?C REGIS ATION NO ❑ COUNTY aS _I - No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 TYPE OF CONNEC ION LENGTH FROM ! SEPTIC TANK SEEPAGEPIT 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 WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO ALTER ABADON SEWER OR DAIROS L SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CO ACT W THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESC BED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS AY OF 19_ NEW HOUSE SEWER �►� OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD 1 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 IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGEL Y AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THE LE OWNE OF THE ABOVE DESCRIBED RESIDENT P OPERT BACKFILL SEPTIC TANKS ❑ SIGNATURE SE PITS ❑ CESSPOOLS OF PERMITTEE OF ALIDATION ROBERT A WOOD CK N 0 CASH SUPERVISING MECHANICAL ENGINEER M 8 7 8 8 2 my-1 '7 1 c p 500 I TEMPLE CITY 6► CE808 a sa APPLICATION FOR PERMIT eeoe COUNTY OF LOS ANGELES SEWER DLSPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS IOAN A LAMBIE County Engineer CAWATT D GRIFFIN Supt of Buildma LOCALITY NEAREST FOR APPLICANT TO FILL IN X CROSS ST LEGAL y DESCRIPTION LOT NO OWNER / J BLOCK TRACT MAIL ADD S NO OFBLDGS SIZE OF LOT NOW ON LOT CIT TEL NO USE OF BUILDINGS DISTRICT NO GROUP BK PG MAP PROCES*D BY cr I CONTRACTOR ADDRES CONNECTI ATA CITY f NO TI DEPTH /� /STATE MANHOLE REF REN PPE REGISTR ON NO D�""l- ❑ COUNTY NO DESCRIPTION OF WORK FEEi HOUSE SEWER CONNECTING TO PUBLIC SEWER --@ $3 00ypE OF CONNECT ON 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 WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT N6 ALTER REPAIR OR ABANDONHOUSE STATE ENCROACHMENT SEWER OR DISPOS L SYSTEM @ $100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OVatRS 1 PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS D TE 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 ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS ALTER REPAIR SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED LOS ANGELES TY AND STATE OF DISCONNECT ABANDON HOUSE SEWER CALIFORNIA OR THAT I M THE WN OF THE ABOVE DESCRIBED RESIDEN L P OPERT BACKFILL SEPTIC TANKS ❑ SIGNATURE SE PIT(S) ❑ CESSP00 OF PERMITTE OF — VALIDATION ROBERT A WOOD CIC H o CASH SUPERVISING MECHANICAL ENGINEER LACo$ 7891503 NOV 17 0 25.00 9� 16*