HomeMy Public PortalAbout5329 FARAGO AVE_Sewer__ I
7GA6420
S&E 66311 SS APPLICATION FOR PERMIT 1
]DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engmeer
County of Loa Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEERADDRESS 5329 Fara{o
® CASSATT D GRIFFIN SUP T OF BUILDING��j LOCALITY
dem i e (11-hiur
FOR APPLICANT TO FILL IN ce0',sr Freer St:.
LEGAL /' OWNER J. h r�l�
_DESCRIPTION LOT NO 4 _ � R� QIP P ll 4 tY'll f ti ()Tl Cc)
MAIL
BLOCK TRACT
2/-,389 ADDRESS 272Y/ San Gabriel Blvd,
I
NO OF BLDGS
_SIZE OF LOT NOW ON LOT CITY �,., TEL NO
USE OF
BUILDINGS Resl�ence '' DISTRICT NO GROUP MAP
..� �
K PGS('/
CONTRACTOR L. D e M. ConsGruct10 � � � (J
ADDRESS 5156 IT. Bleecker CONNECTION DATA
STATION 2toDEPTH
CITBaldwin Park TEL NO ED 8-5024 MANHOLE REFERENCE UPPER
lK STATE
REGISTRATION NO 113613 ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION/,-- LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P�L M L TOP L QC_
PUBLIC SEWER @ $3J90
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO �f
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO JOB NO /
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 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 pEItMIT $ 0, 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE O Q
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 Npw
SEPTIC TANK 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
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS A LES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM T L A OWNER OF THE ABO
DESCRIBED RESIDE OPT BACKFILL SEPTIC TANKS[ISIGNATURE
SEEP PIT(S) El CESSPOOLS C1
OF PERMITTEE -
JOHN A LAMBIE COUNTY E (NEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK Al 0 CASH
LACO5765U OCT 1510 A 500