HomeMy Public PortalAbout5332 FARAGO AVE_Sewer__ .// APPLICATION
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 'BUILDING
IOHN A. LAMBIE, County Eagmeer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. 1
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
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ADDRESS
+� �F
SIZE OF LOT / / [✓ NOW ONBLOT S CITY TEL.N0.
USE OF 4
BUILDINGS �% ! DISTRICT NO. GROUP MAP
' CONTRACT R :
BK PG
ADDRESS `_$ q CONNECTION DATA
CITY Vt"�/—y,_, TEL.NO 0� , STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. LC ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO L
PUBLIC SEWER @ TYPE OF CONNECIM917---�k LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB ( P.L. P M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 �F�
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 F TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCRO MENT
` PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 00 CONNECTION GE FEE
AUTHORIZATION TOTAL FEE -. F#tl-':dv -
REIMBURSEMEN FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL -
OWNERS AGENT P—' BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY L ANGELES COUNTY AND STATE OF s, DISCONNECT PLUG AND
kk CALIFORNIA OR THAT I AM T E AL 0Yy�t�� OF TH ABOVE ABANDON HOUSE SEWER
6f DESCRIBED RESID IAL PRO 1' // x{ BACKFILL SEPTIC TANKS ❑
SIGNATURE t• l/ � SEEP. PIT(S) Cl CESSPOOLS ❑
OF PERMITTEE
®P LIDATION ROBERT A. WOOD
Cr. M.O. CASH SUPERVISING MECHANICAL ENGINEER
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