HomeMy Public PortalAbout5330 FARAGO AVE_Sewer__ J
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S&E89 11 89
APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 5330 Farago S Greet
® ammu CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN CROSS sT F
reer Street
LEGAL (1
DESCRIPTION LOT NO OWNER J. B. Weber Construction CO
7
MAIL
BLOCK TRACT 24389 ADDRESS 272Y2 San Gabriel Blvd.
NO OF BLDGS
SIZE OF LOT NOW ON LOT 2 CITY 1 TEL NO ED
USE OF
BUILDINGS Residence DISTRICT NO GROUP MAP PG
}� I BK
CONTRACTOR Z D Q& M C -5
ADDRESS CONNECTION DATA
��E� Ij. EleeckeL StIj. EleeckeL� St.
CIT,Baldwin Park TEL NO ED 8-3024 STATION DEPTH
MANHOLE REFERENCE OUPPER
CK STATE
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
PUBLIC SEWER @ $g Y CURB P L M L TOP L
37
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P CP C NO
EXTN CESSPOOL DRYWELL MANHOLE Q $2 00 CO IMP NO JOB NO
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 PERNUT 00
AUTHORIZATION I TOTAL FEE 00
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 ORBUILDING OR WORK
New OWNERS AGENT SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATj
CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT ALAREG
M
WITH ALL COUNTY ORDINANCES AND STATATALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLYNDDISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CTEABANDON HOUSE SEWER
CALIFORNIA OR THAT I AMTHE EGAL O
DESCRIBED RESIDENT ROPE BACKFILL SEPTIC TANKS❑
SEEP PIT(S) EICESSPOOLS❑
SIGNATURE
OF PERMITTEE
JOHN A LAMBIE COUNTY NGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
�K I.ACO 5 7 6 B0� OCT 15 1 0 A 500Iz