HomeMy Public PortalAbout5240 FARAGO AVE_Sewer__ DFPARTMENT OF COUNTY ENGLNEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY
PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY T
BUILDING ? �C' ^ NEAREST
ADDRESS � � /�, �-��A ! � CROSS ST
T— -^ DISTRICT0 SERI 0 PERMIT NO
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LOCALITY'7-�� C�i [.p�,I�� 20,72's 7 J
NEAREST e n
CROSS ST RECEIVED B Ready for Inspection DATE ISSCUEGD,�
OWNER M l��/� Q� /.r 3/�/✓ /
ADDRESS ��fy 1�,MAIL USE ZON OCCUPANCY BIC MAP PG
CITY TEL NO 7
CONTRACTOR Nottingham C^ of T......_1_ n.a. CO IMP NO / ?j 3 J ��
ADDRESS 5933 N, CLOVFRI Y AVE JOB NO
CITY ITEMPL&CLI"CALIF. TRUNK PERMIT NO
STATE
REGISTRATION NO COUNTY ROAD PERMIT NOLEGAL
DESCRIPTION LOT NO n 0 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT /I Y 9 7 IV CSA' INDUSTRIAL
WASTE APPROVAL
NO OF
SIZE OF LOT xy NOW ON LOTS ( C H APAES
USE OFBUILDINGSs iQ O CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FE`
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 a RECEIPT NO I \DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO
ALTER OR REPAIR EXISTING I DATE\ 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 ��C� �� S DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 /&MANHOPL�ERREFERENCE LOWER
TYPE OE-OO CTION LENGTH FROM /X14
OWNERS PERMIT $ I 1 00 C cd ML TO P L Q
AUTHORIZATION I TOTAL FEE
CONTRACTOR HAVE TO CONNECT DATE THEED TOABOVE DESCRIBED WITH THE HEREI
SCRIBEDI EXISTING ED APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS I _ _ DAY OF _ Iq NEW HOUSE SEWER ��jydG 3—�
OWNER OR I CONNECT ADDITIONAL
OWNERS AGENT .Qr _ _ _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADOREs2 O t ! _ AHD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLI CESSPOOL[:] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS i ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS 1 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABODf�CW1 PERTY BACKFILL SEPTIC TANKS�
fr►. SEEP PITS)E] CESSPOOLS B- s
SIGNATURE
OF PERMITT _
76A642A 6G3 7/ A. r