HomeMy Public PortalAbout5310 FARAGO AVE_Sewer__ E8081
C 1 a� -APPLICATION FOR PERMIT ,
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL . r
T DEPARTMENT OF COUNTY ENGINEEL.FAD
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BUILDING AND SAFETY DMSIONILDING �-'
JOHN A LAM M County Engmeer DRESS 10 Fara O,_
CASSATf D GRIFFIN Supt of BuildingCALITY Te31e `x%11 'FOR APPLICANT TO FILL IN OSS ST Tr a e r StLEGAL
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DESCRIPTION LOT NO OWNER J. B:. �f1- e_r Cons trU c c';i ' V .
MAIL
BLOCK TRACT 2LL U 'ADDRESS 2/21� Saa-LTa br x el Blrtr&:NO OF
7 W �
SIZE OF LOT NOW ONBLOT S 2 CITY San Gabrie lTEL7NOr AT 2-0531 ,r /i ,,
USE OF
BUILDINGS Res-Ldeflce DISTRICT NO GROUP I MAP
D. {� M /r BK PG
CONTRACTOR L. D. l M. Construction
ADDRESS 136 1d. E-leec'_„er St. CO ON DATA P k
CITY a] ji l Y) P-r1r TEL NO ED 8-5024 4 STATION d6LYtDEP H
STATE MANHOLE REFERENCE
REGISTRATION NORI �� COUNTY LOWER
No DESCPTION F W RK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 Q TYPE OF CONNECTION LENGTH FROM cc��
SEPTIC TANK SEEPAGE PIT OR Y CURB L M L TOP L oL
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO !7
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO f
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEET 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
DAY OF y ry 4 19_ NEW HOUSE SEWER �Q
OWNER OR ,- -- New- - -- ---- 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 �� d5s T1
AND STATE THAT THE-ABOVE IS CORRECT,_AND AGREE-TO COMPLY- CESSPOOL❑ DRYWELL 0-- -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
I-HEREBY CERTIFY THAT I AM PROPERLY REGISTERED'AND/OR_ `SEWAGE DISPOSAL SYSTEM-- -- ,--- .-�.--K
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM_T � EGAL„OWNER OF THE ROVE_ ABANDON HOUSE SEWER__
DESCRIBED RESIDEN PRO TY BACKFILL SEPTIC TANKS ❑
SIGNATURE �T SEEP PITS) El CESSPOOLS [:1
OF PERMITTE
Or N �T' ' l" � VALIDATION` ROBERT A
CK N O CASH SUPERVISING MECHANICAL ENGINEER
!A�o 5 7 7 or N) OCT 1 5-10 R_ 5-0-0-
_M__
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1104250002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID ISEWER / SEPTIC SEWER BUILDING ADDRESS I
ITR 24389 LT 13 (EXIST OCC GRP 1 5310 FARAGO AV 1
I JBLDGS NOW ON LOT TEMP CA 917803531 I
(ASSESSOR INFORMATION NUMBER (CONNECTION TYPE I NEAREST CROSS STREET 1
18573 036 007 (ORIGINATION I THOMAS PAGE 597 GRID D3 LOCALITY TEMPLE CITY Cl
I ILENGTH ML TO PL STATION DEPTH I I
ITENANT IMANHOLE REFERENCE UPPER/LOWER (ISSUED ON PROCESSED BY I
1 1 104/25/11 SR I
I ICOUNTY IMPROVEMENT NUMBER I
OWNER TEL NO IPLAN CHECK NUMBER i FIDA'j'E FINAL,@Y CODE
ICOBB ANA (323) 244 5727 (JOB NUMBER
5310 FARAGO AV TRUNK PERMIT NUMBER
ITEMP 917803531 (ROAD PERMIT NUMBER IDE CRIPTION OF WORK 1
I IAFFADAVIT NO (INSTALL SEWER CLEAN OUT 1
DIVER NO I I
(APPLICANT TEL NO (EASEMENT NO I I
IRESCUE ROOTER (626) 858 7284 1 I 1
1475 E ARROW HWY IRECORD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS I
JAZUSA CA 91702 IHIGHWAY/STREET WIDENING 1
STATE ENCROACHMENT PERMIT NUMBER
ICONTRACTOR TEL NO I FEES PAID 1APFR�AL D TE INSPECTOR SIGNATURE 1
IRESCUE ROOTER (626) 858 9284 1 1
1475 E ARROW HWY LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT 1NEP HOUSE SEWER
JAZUSA CA 91702 765155 C36 I I 1 1 1
1 101 PERMIT ISSUANCE FEE 27 80 ICONNECT ADDITIONAL I I I
1 115 ALT/REP HOUSE SEWER 1 00 EAC 30 40 IBUILDING OR WORK 1 1
1ARCHITECT OR ENGINEER TEL NO I TOTAL FEES 58 20 1 I I I
I I ISEPTIC TANK SEEPAGE PITI I I
I LIC NO I JANE/OR DRAIN FIELD I I
I I I I I I
1 IDRYWELL
I i I I I I
I SEWER MAP BOOK PAGE JALTER REPAIR SEWER OR I I I
I 1SEL%AGE DISPOSAL SYSTEM 1 1
J IDISCONNECT PLUG AND
I I 1ABANDON HOUSE SEWER I 1
I i IBACKFILL SEPTIC TANKS
ISEEP PIT _ CESSPOOL
I I I I I I
1 JGRFYWATER SYSTEM I I I
I I I I I I
I J I I I I
I I I I I I
I I I I I I
I i I I I I
I IREPORT ID DPR266 ROUTE TO BS0508 1 I I 1
I I I I I I