HomeMy Public PortalAbout5320 FARAGO AVE_Sewer__ ,` APPLICATION �.yq
S&E48 91155 • •P• LICA TION FO. ■ PERMIT 1
"'DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engmeer
County of Los Angeles BUILDINADDRESS �, () r+a rp
JOHN A LAMBIE COUNTY ENGINEER 5
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN ceOSS ST FI Y'P AT' S r .
LEGAL T�
DESCRIPTION LOT NO 11 OWNER �J� B. Weber Cons uru C T1on
MA IL
BLOCK TRACT 2LL380 ADDRESS 272/2 San Gabriel Blvd•
NO OF
SIZE OF LOT NOW ON LOTS 2 CITY San Gabriel TEL NO AT 7-0c,31
USE OF
BUILDINGS Residence DISTRICT NO GROUP MAP
BK PG
--��`` Art j � T7 P
CONTRACTOR L. j�e & M. Construction '�
e
ADDRESS 51 3Gi N. Bleecker St. CO CTION DATAt
CITY -) �r r TEL NO _ STATION DEPTH /
RQ_ _ _ _ r MANHOLE REFERENCE UPPER
STATE LOWER
REGISTRATION NO7 ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y CURB PL M L TOPL
PUBLIC SEWER ea $3 :Z166-
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO �� y
EXTN CESSPOOL DRYWELL MANHOLE Q $ 2 00 CO IMP NO JOB NO /
HOUSE SEWER CONNECTING TO T—_�--
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT S 00
AUTHORIZATION 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
i
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS AGENT VV I,Te.(.v 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS GELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T EGAL OWNER OF TH ABOVE
DESCRIBED RESIDENT PROP TY BACKFILL SEPTIC TANKS C1SIGNATURE SEEP PITS) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COUNTY EidGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
�K L� 5 7 c6R 8 OCT 15 10 A t0
500