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Home My Public Portal About5221 FARAGO AVE_Sewer__ A I76 4"2 76A642L APPLICATION FOR PERMIT 64 u COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO 14 OWNER 16A 2 MAIL BLOCK TRACT ADDRESS /NO OF BLDG$ SIZE OF LOT NOW ON LOT CITY TEL NO U Ll 14 USE OF BUILDINGS DISTRICT NO 0140111 //BK MAP P PROCESS BY CONTRACTOR S -r `J f 2 , ADDRESS t NNECTION DATA YW STATION DEPTH CITU TEL NO UPPER STATE LIC MANHOLE FERENCE LICENSE NO / CLASS LOWER NO DESCRIPTION OF RK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L TO P L PUBLIC SEWER @ PC NO CL SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO O PITS AND/OR DRAINFIELD HOUSE SEWER CONNECTING TO � TRUNK PERMIT NO ROAD RMIT NO V PRIVATE DISPOSAL SYSTEM CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD fNSTR NO DATE O WORISTO HOUSE SEWER f' OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ STATE ENCROACHMENT z PERMIT NO INDUSTRIAL OWNERS PERMIT WASTE APPROVAL CHARGES s N `�� AUTHORIZATIONI TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO COY NECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS 1:� DAY OF 1923 OWNER ORNEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANKSEEP PIT(S) �d"r I HEREBY ACKNOWLEDGE THAT I HAVE AD THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IS CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT IAM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS OF PERMfTTEE ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ coLIDATION M 0 CASH 847cc--JUN 0 ,n 9110 ®� C� Cox so, 78A842D +� L;j I O N FOR P R M I T cEeo fi,99JBDING UNTY OF LOS ANGELES i 1 DMENT OF COUNTY ENGINEER SEWER DISPOSAL AND SAFETY DIBVI�SION DDRESSG +�T0113NT D GRUTIN SuLAMIE pt of Building LOCALITY Z F / NEAREST F APPLICANT TO IN "OSS ST FDESCRIPTIODJ LOT NO L OWNER TRACT MAILADDRESS0OFBLDGS NONPON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCES BY BUILDINGS O�) Y I BK PG I L -� CONTRA � �--�- ��'�-=t` � J� ADDRESS CONNECTION DATA ' CITY TEL NO �' TION DEPTH ✓ STATE M NHOLE REFERENCE / PER REGISTRATION NO COUNTY (p Ze 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 Oda j HOUSE SEWER CONNECTING TO 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 ABANDON HOUSESTATE ENCROACHMENT SEWER ORD[S POSAL SYSTEM @ $100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE ClZ) REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS D�F 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT A BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD IH 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 THA 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED LOS ANGE ES COUNTY AND TATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LE ER OF E ABOVE DESCRIBED RESIDENTI ROPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURECk SEEP T(S) ❑ CESSPOO S OF PERMITTE VALIDATION ROBERT A WOOD CILM o cpyb SUPERVISING MECHANICAL ENGINEER Z=a� �js" :--71� IC,.,:5950 - SEP 21 1 D 2500 (0o �� a � llr6 R 6PLICA ERMIT ceao}11 sa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 D ARTMENT OF COUNTY ENGINEER UMDING AND SAFETY DIVISION BUILDING �t'�^` JOHN A LAMBIE County En eer ADDRESS / CT`'a O CASSAIT D GRIFFIN Supt of Building LOCAL;Z� OR APPLIC TO FILL IN ceoss sr LEGAL 61 DESCRIPTIO LOT NO OWNER BLOCK TRACT MAIL 4e�tr P ADDRESS NO dr BL GS SIZE OF LOT NOW ON LOT CITY TEL NO USE BUILDINGS BK DISTRICT NO GROUP MAP PG PROCESS YY I I CONTRACTOR ADDRESS CONNECTION DATA CITY TEL oN�O �j fill ON DEPTH REGISTRATION NO / / ® STATE p HOLE REFER NCE PPE COUNTY NO. I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ,per PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM {� SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L J 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 WORK CONNECT H ADDITIONALUSE BLDG OR @ $1 00 TRUNK PERMIT NO ROAD PERMIT NOI , ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE CON TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTDATE A CONTRACT WITH THE IINGAMED DWELLIING APPROVALS DATE INSP CTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THISAY OF 19- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT Z BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1HAVE 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 SEWEROR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY TH 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED Y LOS A COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAJ AM THE LEGA OWN OF THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDEN OPERTY S P PIT(S) ❑ CESSPOOLS SIGNATURE OF PERMITTEso ®" �,� VALIDATION ROBERT A WOOD CR m 0 CAStl SUPERVISING MECHANICAL, ENGINEER 9 4 9 112 S SEP 2 1 5 00 t