HomeMy Public PortalAbout4841 PERSIMMON AVE_Sewer__ DEPAKTnrENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CCUNTY ENGINEER I 13UILDING
ADDRESS ,'
FOR APPLICANT TO FILL IN LOCALITY y
BUILDING a NEAREST
ADDRESS CROSS ST.
LOCALITYS
DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST i A �`7
CROSS ST. .
RECEIVED BY Ready for Inspection DATE ISSUED
OWNERr
MAILL,� USE ZONE' OCCUPANCY MAP
ADDRESS r` ( BK PG
CITY TEL.NO.
CONTRACTOR CO.IMP.NO.
ADDRESS 7; ' l, TE r
JOB NQ,
CITY 1 t(,,1j llo TEL.NOa',4 on TRUNK PER T NO.
4 F-1 STATE REGISTRATION N0.r !445 J;,rjj COUNTY a.
ROAD PERMIT NO.
LEGAL STATE ENCROACHMEN
DESCRIPTION LOT NO. t PERMIT N0.
BLOCK / TRACT .,� INDUSTRIAL
WASTE APPROVAL
SIZE OF LO N0.OF OT
OGS x"
NOW ON LLOT � ARG
USE OF
BUILDINGS k CONNECTION CHARGEXE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT EE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 _ RECEIPT I DATE 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
IS _
DCONNECT AND ANN SABDOEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRA!NFIELD 2.00
CESSPOOL—DRYWELL STATION DEPTH
j•
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. - M.L.TO P.L.
AUTHORIZATION TOTAL FEE p:/ -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER �q
SIGNED THIS.__, ... ... Y OF__.,l/'... ...___...I9__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT. ._ ... ....... .. ...... ...._-_ _...._._ BUILDING OR WORK
......_..
ADDRESS------- f y - SEPTIC TANK,SEEP.PIT(S)
_._._...- -- - .-•-----------•---------------- AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAI- THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE I i` SEEP.PIT(S)D CESSPOOLS 0
OF PERMITTEE;:_ �--------------- ------
76AO42D 663 1/53
;�A° o '` " APPLICATION FOR P IT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRE59 o� y ZZ
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Zj� -'
LEGAL
DESCRIPTION LOT NO. OWNER ,r
MAIL
BLOCK TRACT ADDRESS
NO, OF BLDGS,
612E OF LOT �• ^ NOW ON LOT CITY " -�� E.L. NO. .!
USE OF
BUILDINGS — DISTRICT{O. GROUP BK MAP PG PROCES"ID BY
CONTRACTORJO/ C.-d 414
ADDRESS C CONNECTION DATA
CITY TEL NO.
�/y'^'' STATION DEPTH
�3. �y
STATE '=F- LIC MANHOLE REFERENCE �' �f
LICENSE NO. CLASS NNCE _ ,��-`i`— y LOWER
NO. DESCRIPTION OF WORK FEE` N
TYPE OF C
_ ONNECTION LEGTH F OM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TOP.
PUBLIC SEWER ;5.00 -�—'-- —' "--
SEPTIC TANK,SEEPAGE PIT OR - - NO_
CO.IMP.NO. JOB JOB NO.
�PITS AND;'OR DRAINFIELD '� ;10:00
MOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ .$.3.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVITWAITER EASEY EMT RECORD.INSTR.NO� DATE C-3--I--WORK TO HOUSE SEWER 0 $3.00 I -
I OVERFLOW SEEPAGE PIT DRAINFIELD ---- _�--_____ O
EXT N.CESSPOOL.DRY WE4L.MANHOLE $5.00 1
HWY.OR ST.WIDENING V
{'M!T!'R;^1fMi1�R�OR ABA NOON HOUSE _— .._._.___
5EViER_O 'ilL 9Y57 F_M $3_00 L.!, C� -STATE ENCROACHMENT [L
PERMIT. NO.
-' -'---�-- -{---- INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT _ _s —2 o�o ---- —_---------_.—_ T. _— --
AUTHORIZATION TOTAL FEE C'L' CONNECTION CHARGE FEE
. I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO..CONNECT THE ABOVE DESCRIBED EX!'TING DWELLING - APPROVALS V N
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF—_19—
OWNER
F _19—
_---' --- ---- ---
OWNER OR NEW HOUSE SEWER
OWNERS AGENT" ^CONNECT ADDITIONAL
BUILDING OR WORK
IRESIDE
DRESS_ _ _ ---
SEPTIC TANK,SEEP.PIT($)
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
D STATE THAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY
TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
UMBING AND SEWERS. / CESSPOOL ❑ DRYWELL ❑ i __ __
HEREBY CERTIFY THAT i AM PROPERLY REGISTERED .AND/OR ALTER,REPAIR.SEWER OR
ENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEMIIFORNiA OR THAT I AM THE LEGAL OWNER OF, AND INTEND 70 DISCONNECT' PLUG ANO IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER III
h
SIGNATURE � � /,.✓ e BACK FILL SEPTIC TANKS ❑ —` - --'—
OF PfRM4T E —�•�„ SEEP.PIT IS) ❑ CESSPOOLS ❑
VALIDATION_ JACK R. ALLEN
CK.
SUPERVISING MECHANICAL ENGINEER
M.O. ��CASH
! a