HomeMy Public PortalAbout5333 FARAGO AVE_Sewer__ sgWs 311 '39 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING C
JOHN A LAMBIE COUNTY ENGINEER ADDRESS L333 Farego
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Temrl e City
FOR APPLICANT TO FILL IN
NEAREST
Freer St.
LEGAL
DESCRIPTION LOT NO 5 OWNER eT� B. IV(- (-r Constructs-on C .
24 ,89 ADDRESS ?7?y2 San Gabriel Blvd.
MAIL
BLOCK TRACT 1
NO OF BLT 2 CITY San Gabrie lTEL NO AT ("0531
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP MAP
BUILDINGS p 'I (�1 BK PG
CONTRACTOR L, D. & L. Cons tlui c is on
ADDRESSCONNECTION DATA
9136 N Bleecker St.
STATION 7'5 . DEPTH
CITY Baldvl2n 1 T�arkTEL NO ED
�— 024 MANHOLE REFERENCE PPER
1K STATE
REGISTRATION NO 113813 ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
Y CURB &PL M L TOPL Rd
IL PUBLIC SEWER @ $36b CQ
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
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 r@ $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PEST $ 00
AUTHORIZATION I TOTAL FEE -5-1 de 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 Q ro �
TO THE PUBLIC SEWER NEW HOUSE SEWER i
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT New
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 ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T GAL OWNER OF THE ABO
DESCRIBED RESIDEN ROP TY BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PITS) ❑ CESSPOOLS[I
OF PERMITTE�,, 164
JOHN A LAMBIE COUNTY RWGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
cK �A. 5 7 5� OCT 15 10 A 5 0 n