HomeMy Public PortalAbout5317 FARAGO AVE_Sewer__ 5
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S&g/669 11 SS APPLICATION FOR PERMIT 1
9 @ 68
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 531,7 Farago
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Temple Ci y
FOR APPLICANT TO FILL IN CROSS sT F
rePr Vit.
LEGAL
DESCRIPTION LOT NO 2 OWNER el T
R C nns i-r1j ''t-1 oj�, C
Al L
BLOCK TRACT 2LL389 ADDRESS 272/2 Spn Ggb-m PI Blvd
SIZE OF LOT NOW .
NO OON LOOTS 2CITY San Gabriel TEL NO AT 7-05311
USE OF DISTRICT NO GROUP MAP
BUILDINGS Residence BK PG
CONTRACTOFIL D & M. 0
onstrgiom cm
ADDRESS 5136 F'T.� Bl e e cke r CONNECTION DATA
CITY Baldwin alkTEL NO ED S— 024 STATION i Q DEPTH
1
MANHOLE REFERENCE ✓ -
REGISTRATION NO 113613 [1COUT TY OWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECT[O LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURBP L M L TO P L /
PUBLIC SEWER @ $3 � (ems
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO JOB NO ! /
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S pERIVIIT $ ,g o0
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I 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 NAW SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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 I
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T GAL OWNER OF THE ABOVE
DESCRIBED RESIDENT PRO TY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERMITT
JOHN A LAMBIE COUNTY ±NGINEFR VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CI; �.A.Co 5 7�6H 6 m OCT 15 10 A 5 00