HomeMy Public PortalAbout4824 PERSIMMON AVE_Sewer__ n�asza»e OF COUI Y ENG, SEWER—SEWAGE DISPOSAL 1
DIVISION OF BMLDING AND SAFETY PERMIT APPLICATION
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WILLIAM J. FOX. COUNTY ENmimmrn I BUILDING 4 � U
ADDRE8S
FOR APPLIC T TO FILL IN LOCALITY ,
BUILDING "'f// a A NEAREST e
ADDRESS
---fit� +A•�y 1 / CROSS ST. ,9 ,.�.)",� „ty�'iJ�v(dJ
LOCALITY DISTRICT NO. Ready for Inspection PERMIT NO.
NEAREST %! e,!Zq— S
CROSS ST.
s
RE�yCEIVED BY DIS UED)3Y DATE
OWNER ✓1. �Z.f /,?—?-•ATE o &4 -, /;P,i,'°-N-.
MAIL (3 C USE ZONE OCC PANCY D BK MAP PO
ADDRESS
CITY TEL.NO. e /
CONTRACTORCa.l•li ornlA ewerO a o aaaa
`
ADDRESS 1317 COlegrove VO% CO.L*P.N0.
JOB NO.
CITY Montebello TEL.NO: _ y
55- TRUNK PERM 4`NO.WATE
/
REGISTRATION NO.1 04445 COUNTY ROAD PERMIT N0. /
LEGAL
DESCRIPTION LOT NO. �Jf� STATE ENCROACHMENT
PERMIT N0. .-
BLOCK 4 TRACT 4-Ag INDUSTRIAL / \
SIZE OF LO N0.OF BL WASTE APPROVAL
O � ����� NOW ON LOT
� CHARGES\
USE OF
BUILDINGS (r+"� CONNECTI0N CHARGE FEE
NO. DESCRIPTION OF WORK FEE 1
HOUSE SEWER CONNECTING TOs.� REIN15URSEMENT FEE
PUBLIC SEWER @ ! 3.60 C-1r ECEIPT NO. .I DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
-ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00. STATION x J7, DEPTH
CESSP00 L—DRY W EL L
SPECIAL CONDITIONS ONLY 2.00Gy'7 MANHOLE REFERENCE
aC /� Up4tBG LOWER
TYPE OF CONNECTION LENGTH FROM I
OWNERS PERMIT $ I 00 wr CUM P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE _b
1 HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER)
.SIGNED THIS�,DAY OF _______ JOWN-
NEW HOUSE SEWER � �,+,��•;?/.,� 1p_Ap
' 111 CONNECT ADDITIDNAL
OWNER OR - j• 4 Lr.. � •.OWNERS AGENT. sBUILDING OR WORK
ADDRESS..._......_ _. . SEPTIC TANK.SEEP.PITS)
-- -- AND/OR DRAINFIELD
1HEREBY ACKNOWLEDGE TNAT 1 HAVE READ TPLI• CESSPOOL DRYWELL
CATION AND STATE THATTHE ABOVEIS CORRECT REETO COMPLY WITH ALL COUNTY ORDINANCES AND SWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS: SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY RREDAND/OR LICENSED AS REQUIRED BY LOS ANGELNTY DISCONNECT PLUG AND
A D STATE OF CALIFORNIA OR THAT I AM THE LWN- ABANDON HOUSE SEWER
ER OF THE ABOVE ESC IBED RESIDENTIAL PROBACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)� CESSPOOLS[]
OFPERMITTEF +Sr s f __.. � x
76A642D S&E 663 4/54 'Oki.
4- 4;r; APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEVVAGE DISPOSAL j
0 E P A R TIMF'NT ,_it C,'�1!NTY ENGINEER
r
4 ki I L Q!N,G 0,,N 0,' E-r y DI vi s 10 N 13U I L 0 1 NG FAADDRESS
X�
JOHN A. LAM SIE, COUNTY ENGINEER
COLEMAN VNI. JLNKINS, SOP T. OF BUILDING
L L
OCALITY
NEAREST
OR APPLICANT TO FILL IN C R CCI�S 5 .5 T
IPRiNT OR TYPE ONLY)
LOT NO.
DESCRIPTION OWN j
MAIL
BLOCK v^a TRACT ADDRESS
NO. OF SLOGS..
SIZE OF LOT NOW ON LOT C!TY TEL. NO.
USE OF 0 1;P C�LA 5,5 OCESSE-D BY
-D�STRICT 1,10.1 GR M,A P PR
BUILDINrS
coNTRACTOR
ADDRESS Jlj CONNECTION DATA
7Y jSTATION DEPTH
l� TEL
STA r�E LIC
,:!:ENSE NO; MANHOLE REFERENCE ----LpWER
TYPE OF CONNECTIONLENGTH FROM
NO DESCRIPTION OF WORK FEE
4 —-- - -
r4o-u-SE.SrW-ER-CONNECTING TO Yl CURBP*+. !,L.TOP.L.
LPUBLIC SEWER S.Do
Co.IMP.NO. J NO
PITS AND/OP DRAINFIELD $1000
HOUSE SEWER CONNECTING 70 RUNK PERMIT NOlROAD PERMIT NO. a,
PRIVATE DISPOSAL SYSTEM ®R $3.00 0
W�V�'ZA—MEN
AFFICYAVIT E 5F
IONNE�,7 ADDITIONAL SLOG,OR NT Ri-2 .p INS
WORK TO HOUSE.SEWER @ $3.00
OVERFLOW SEEPAGE PIT,ORAINFIELD
EXTN..CE55POOL.DRYWELL.M.ANHOLL
HWY, OR ST.WIDENING
A NOON HOUSE
--R-D $300 �j
STATE ENCROACHMENT _il
PERMIT NO,
I N D U STR I AL
WASTE APPROVAL
OWNER's PERMIT 46
��jAUTHORIZATION TOTAL FEE 1 'a� '� CHARGES o CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
T RACTOR TO CONNECT THE ABOVE, DESCRIBED EXISTING DWELLING
APPROV DATE fNSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER ALS
S!GNED THIS DAY OF 19 ------
OWNER OR _N.W SEWER
- -N--
OWNERS AGENT 1 111 —fC) AL--
E�CONNCT ADD T
BUILDING OR WORK
ADDRESS TIC TANK.SEEP,PIT(S)
A( T I HAVE READ T�15 APPLICATION
1 H ERESY �K N 0 V L,�,:11.1:i7 A AED/OP.ORAANFIELD
VE
AND STATE 'THAT HE ABL VE IS CORRE C r AND AGREE TO COMPLY
WITH ALI. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL El DRYWFLL i
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICEN S FDAS REQUIRED
BY LOS ANGLES COUNTY AND STATE: OF SEWAGE DISPOSAL SYSTEM
CA'�IFO A OR THAT ; AM THE LEGAL OWNER OF. AND NTENO TO D:SCONN ECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESiDENT!A'- PROPERTY. ABANDON H OUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS
OF PERMITTEE
SEEP.FIT IS) CESSPOOLS
VALID TION
h JACK R. ALLEN
I CASH SUPERVISING MECHANICAL ENGINEER
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