HomeMy Public PortalAbout5337 FARAGO AVE_Sewer__ �f
S&E4631155 APPLICATION FOR PERMIT 1
. DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engmeer
County of Los Angeles BUILDING
Farago
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 5337 Faa
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY TPP 1'i1�_P Cl ty
FOR APPLICANT TO FILL IN CROSS ST Iver Stireet
LEGAL 6 OWNERJ_ R_ Weber i r
DESCRIPTION LOT NO ---.-.r-_��1St2'L C dp_rp--r18
MAIL
BLOCK TRACT 24589 ADDRESS ` ?2? IS',.,,,, /"I�abri,.,'1
NO OFBLDGS CITYSan Gabriel TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS �L R7� s,i d DISTRICT NO G*QUB- BK MAP PG
CONTRACTOR : LT L � :I:— � � Y
ADDRESS 5176 N B ar St.
NECTION CONDATA57
CITY Bal dwi.a Park TEL NO DD 8-3024 STATION /i Q DEPTH
MANHOLE REFERENCE
:MQ STATE
REGISTRATION NO 115613 ❑ COUNTY LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM Q
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L 02i
PUBLIC SEWER @ $3&0 B
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO 10B No
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
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 PERMIT $ 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE o D
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
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 TH EGAL OWNER OF THE ABOV
DESCRIBED RESIDENTI�PROPE BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTE
JOHN A LAMBIE COUNTY E GINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
m 0 CASH
(_,C 5 7 6 3 DO OCT 15 10 k 500 �;
I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1205220009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
(LEGAL ID (SEWER / SEPTIC SEWER BUILDING ADDRESS
ITR 24389 LT 6 (EXIST OCC GRP 5337 FARAGO AV
I IBLDGS NOW ON LOT I TEMP CA 917803532
(ASSESSOR INFORMATION NUMBER (CONNECTION TYPE I NEAREST CROSS STREET
18573 035 006 (ORIGINATION I THOMAS PAGE 597 GRID D3 LOCALITY TEMPLE CITY Cl
I ILENGTH ML TO PL STATION DEPTH _
ITENANT IMANHOLE REFERENCE UPPER/LOWER IISSJED ON PROCESSED BY
1 1 105/22/12 SR
COUNTY IMPROVEMENT NUMBER
(OWNER TEL NO IPLAN CHECK NUMBER IF NAL DATE FI Y CODE 1
IFRANK I CNGO (626) 279 6335 1JOB NUMBER
15337 FARAGO AV ITRUNK PERMIT NUMBER I � 1
(TEMP 917803532 IROAD PERMIT NUMBER IDES^RIPTION OF WORK
1 IAFFADAVIT NO IINSfALL 4 CLEAN OUT IN Y
1 (WAIVER NO 1+
(APPLICANT TEL NO (EASEMENT NO
IPAYLESS AND PLUMBING (800) 220 0209 1 _
19903 PARAMOUNT BLVD IRECORD INSTRUMENT NBR RECORD DATE ISPFCIAL CONDITIONS
DOWNEY CA 90240 --1HIGHWAY/STREET WIDENING 1 _
1 ISTATE ENCROACHMENT PERMIT NUMBER 1 � __11
(CONTRACTOR TEL NO 1 FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1
IPAYLESS 4 PLUMBING
19903 PARAMOUNT BLVD 302 LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEW MOUSE SEWER 1 I I
IDOWNEY CA 90240 817064
1 101 PERMIT ISSUANCE FEE 27 80 IC014ECT ADDITIONAL I I I
1 115 ALT/REP HOUSE SEWER 1 00 EAC 30 50 IBUJ�DING OR WORK I
ARCHITECT OR ENGINEER TEL NO i TOTAL FEES 58 30 1 I I I
LIC NO ISEPTIC TANK SEEPAGE PITI I
(AND/OR DRAIN FIELD
IDRYKELL
I _
SEWER MAP BOOK PAGE IALTLR REPAIR SEWER OR I
ISEWAGE DISPOSAL SYSTEM
I I I
1 I IDIq ONNECT PLUG AND I I 1
1 I 1ABAIDON HOUSE SEWER 1 1
IBAC�FILL SEPTIC TANKS
ISEFD PIT _ CESSPOOL
GRA�WATER SYSTEM I 1
I
1 I I I I
I I I I I I
I I I I
I _
I I I I I I
I 1 I I I I
I I
REPORT ID DPR266 ROUTE TO BS0508 I I I I
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