HomeMy Public PortalAbout5311 FARAGO AVE_Sewer__ S& 2
E 623 It APPLICATION FOR PERMIT
E DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engmeer
County of LOS Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 5311 Farago
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY TPm nl P City
FOR APPLICANT TO FILL IN NEAREST Freer Street
LEGAL 1 OWNER B . 'Veber Co struct-1 on C
DESCRIPTION LOT NO 1 �
MAIL
BLOCK TRACT 24389 ADDRESS �j N. B1 Aeckyr St
NO OF BLDGS
SIZE OF LOT NOW ON LOT 2 CITY TEL NO R
USE OF
BUILDINGS Residence DISTRICT NO GROUP MAP
p MIf BK PG
&
CONTRACTORS. D. M. Constructio-n
ADDRESS 5136 IT. Bleecker St. CONNECTION DATA
CITY Baldiiin Pc`a2kTEL NO ED 8-3024 STATION Q DEPTH
MANHOLE REFERENCE
REGISTRATION NO 117b12 STATE LOWER
❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 Q
Y CURB p M L TO P L (O
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO JOB NO /
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT $ 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS _ DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR �� BUILDING OR WORK
OWNERS AGENT SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS A D
GELES COUNTY AND STATE OF ABANDON HOUSE SEW
CALIFORNIA OR THAT I AM T LEGAL OWNER OF THE AB VE
ER
DESCRIBED RESIDENT PROP RT BACKFILL SEPTIC TANKS❑
SEEP PIT(S) EICESSPOOLS EDSIGNATURE
OF PERMITTEE
JOHN A LAMBIE COUNT ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
A CK ! 5 7 c6 7 '00) OCT 15 1 0 A 500 N