HomeMy Public PortalAbout5218 FARAGO AVE_Sewer__ IDEPAIiTMENT OF GollNrrY ENGngEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY . PERMIT APPLICATION
COUNTY OF LOS ANGELES v
WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS 4 � A 12 A IWO
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FOR APPLICANT TO FILL IN LOCALITY ZE
BUILDING ss�� NEAREST
ADDRESS �� / E —fA ,R� � � CROSS ST. �� '�E
LOCALITYr/_M ppb C/ Ty
DISTRICT N0. I Ready for Inspection I S
/PERMIT N0. c
NEAREST 5 �(Q �
CROSS ST.
P ECEIVED�Y / DATE ISSUED BY_,�s- DATE
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OWNER RECEIVED
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ADDRESS
- -� JOB N0.
CITY TEL.NO.
TRUNK PERMIT N
STATE
REGISTRATION NO. ® COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMEN
DESCRIPTION LOT N0. PERMIT NO.
BLOCK /J TRACT //�,qZ INDUSTRIAL
/ WASTE APPROVAL
SIZE OF LOT Zt$X_ NOW ON LOTS
C RGES
NO.OF BLOC
USE OF
BUILDINGS fP, ,s'/�/ Q� 0,4,^0jLC elf' CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE /
PUBLIC SEWER @ $ 3.50O
_ -� RECEIPT NO. I DATE N BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED \
_ WORK TO HOUSE SEWER 1.00 0
ALTER OR REPAIR EXISTING ND. DATE I BY\
SEWER OR DISPOSAL SYSTEM 1.00 `
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR ORAINFIELD 2.00 STATION /n pDEPTH
CESSPOOL—D RYW ELL bf
SPECIAL CONDITIONS ONLY 2.00 77 4 MANHOLE REFERENCE
LOWER
TYPE OF CONNECTION LENGTH FROM g��
OWNERS PERMIT ; I 00 Y. P.L. M.L.TO P.L. CJ
AUTHORIZATION TOTAL FEE ,SQ
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
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 APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- / y
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SE❑PTICTANK8E]� L�� �1/ f
SIGNATURE P SEEP.PIT(S) CESSPOOLS
OF PERMITTEE... ��_.. .� GE � ..__._.......
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76A642D S&E 663 4/54
76A862D
CE808 8.89 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING -,0
ADDRESS CL R C
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY .
FOR APPLICANT TO FEAREST
ILL IN
CROSS ST. N Y'
LEGAL OWNER O
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N [GROUP MAP PROCESSED BY
PG
CONTRACTOR Q / /
ADDRESS , CONNECTION DATA
I ARM
CITY "TOg A rj TEL.N0. C �'l d�0 STATION DEPTH
/ � �S f ATE MANHOLE REFERENCE UPPER
REGISTRATI�O. ` / 6- L] COUNTY LOWER
NO. 1 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.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. /,�I JOB NO.
co T D (TION BLDG.0 @-$1.00 �s TRUNK PERMI'II N0. - ''- R
ROAD MIT.NO. ,
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. f
INDUSTRIAL
WASTE APPROVAL
CHAR S
OWNER'S PERMIT S 2 00 CONNECTION CHA E FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEEINAMED CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING 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 ❑ 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 BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM HE LEGAL OWNER OF TH ABOVE
DESCRIBED RESIDENYJ RTYPt BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ElCESSPOOLS ❑
OF PERMITTEE
®? v LIDATION ROBERT A. WOOD
cr. X.0. CASH SUPERVISING MECHANICAL ENGINEER
6 4 61D "''&l 3: 0
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