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Home My Public Portal About5232 FARAGO AVE_Sewer__ DEPARTMENT OF COUNTY ENG NMM SEINER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGEIMS WILLIAM J FOX. COUNTY ENGINEER BUILDING /•, - o ADDRESS FOR APPLICANT-TO FILL IN��,�� pj LOCALITY f4v' ` BUILDING CROSS ST ADDRESS LOCALITY DISTRICT NO Ready for Inspection PERMIT NO !� c NEAREST (� / S CROSS ST RE EI D BY DATE ISS E B.Y- D ' DATE OWNERMAIL _e ADDRESS i-3 �� J�'"'�' U�EZONE n[OCCUPANCY��iiiJ B Q CITY EL.MO (� CONTRACTOR �,� CO IMP NO ADDRESS JOB NO CITY TEL NO TRUNK PERMIT NO REGISTRATION NO 8 COUNTY `` ROAD PERMIT NO LEGAL DESCRIPTION__ LOT NO J j 3 SV STATE ENCROACHMENT PERMIT NO BLOCK TRACT'/ A/ '7 INDUSTRIAL WASTE APPROVAL SIZE OF LOT / _ 3 NOW ON LOTS CHAR3&S USE OF BUILDINGS 774-0 /J j GA,k14 C, jE- CONNECTION CHARGE FEE NO DES RIPTION OF WORK FEE REIMBURSEMENT FEE - HOUSE SEWER CONNECTING TO �� PUBLIC SEWER = 350 RECEIPT NO DATE BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR CEPTION RECORDED _ WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING N I 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 DRAINFIELD 200 STATION`/� DEPTH G CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2 00 �d 5/ MANUHOLE PPER REFERENCE R TYPE OF CONNECTION LENGTH FROM 7�-- �'�.� PL ML TOPL O OWNERS PERMIT ; 1 OD AUTHORIZATION I TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS DAY OF-_ Iq_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ _ _ _ _ _ _ _ _ _ _ _ BUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESSAND/OR DRAINFIELD - - - - - - - - - - - - - - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL E] DRYWELL CATION AND STATE THAT THE ABOVE IS 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 I AM THE LEGAL OWN ER OF THE ABOVE DESCRIBED RESIDENTIAL P OPERTY BACKFILL SEPTIC TANKS 1] SIGNATURE i SEEP PIT(S)[3 CESSPOOLS _ , f OF PERM ITTE V� 76A642D S&E 663 4/54 w✓� /jl ,Q 82 76AB42D APPLICATION FOR PERMIT 78A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESS // JOHN A LAMBIE County Engineer Z3 &/�,WILLIAM A JENSEN Sup t of Bu>ldmg FOR APPLICANT TO FILL IN 7 LEGAL DESCRIPTION LOT NO77-2 o OWNER �(�(J+[,d J MAIL BLOCK J3 TRACT ADDRESS ,Z W vL '7 A NO OF BLDGS E ^ ) SIZE: OF LOT NOW ON LOT CITY TEL NO Al-41: 77 USE OF t BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY /7{13K ) PG CONTRACTOR ADDRESS _ '� \/ CONNECTION DATA CITY TEL NO ^. ^'7 STATION DEPTH TATE MANHOLE REFERENCE UPPER REGISTRATIO NO COUNTY SLOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ $5 00 PC NO V SEPTIC TANK SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL AFFIDAVIT WAIVER E15EMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 _ OVERFLOW SEEPAGE PIT DRAINFIELD H EXTN CESSPOOL DRYWELL MANHOLE @ $500 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL W TE APPROVAL OWNER S PERMIT $ 2 Oo A AUTHORIZATION CONNEC ON CHA E FEE TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIB EXISTING DWELLING TO THE PUBLIC SEWER 3 APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19� OWNER OR NEW HOUSE SEWER 1 t t OWNERS AGENT CONNECT ADDITIONAL q a 16 ? BUILDING OR WORK � ADDRESS /Z 3 Y t v 1 HEREBY ACKNOWLEDGE THAT 1 AVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ II 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 1 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE D RIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS El SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIOI /J ROBERT A WOOD CK M O CASH _ �� SUPERVISING MECHANICAL ENGINEER I � 9,7 0 41 o SEP `p3 1 0 D 5-.00-