HomeMy Public PortalAbout5326 FARAGO AVE_Sewer__ a e6D
s 89 11 SS APPLICATION FOR PERMIT
3 8 E'6
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDINADDRESS 5 j26 Farago
JOHN A LAMBIE COUNTY ENGINEER _
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Tertil P City
FOR APPLICANT TO FILL IN CROSS Sr�
T Freer Street
LEGAL DESCRIPTION LOT NO 10 OWNER J. B, ij>lAr1Ar COn�G r'1� I; On C •
MAIL
BLOCK TRACT 24389 ADDRESS STP?h San G-0-mi-pi Bl velNO
.,
SIZE OF LOT NOWOON LOTS 1 CITY S -n Go p1 TEL NO AT
USE OF OUP MAP
BUILDINGS -Residence DISTRICT NO GROUP
QQ 7n I BK P
CONTRACTOR 1�� '�• C� 11• Lny)��,r17c;-� I nYl _
CONNECTION DATA —�
ADDRESS 51% N. Bleecker
CIT)Baldwi-n Park TEL NO ED 8-3024 STATION 9 DEPTH
Rl STATE MANHOLE REFERENCE PPER
REGISTRATION NO 11513 Cl COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
Y CURB P M L TOP L
PUBLIC SEWER @ $300
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE Q $2 00 CO IMP NO JOB NO �J
HOUSE SEWER CONNECTING TO
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 PERMT Do
AUTHORIZATION TOTAL FEE REIMBURSEMENT 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 �,T BUILDING OR WORK
OWNERS AGENT Nell SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 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
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I 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 TH Y LEGAL OWNER OF THE AB VE
DESCRIBED RESIDENT PROP BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS) ❑ CESSPOOLS❑
OF PERMITTE J
JOHN A LAMBIE COUNTY'ENGINEER �yALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CX
1 5 7� B 9 QCi 1 5 1 o A 5 0 0 ID