HomeMy Public PortalAbout4902 PERSIMMON AVE_Sewer__ DEPARTKENT OF COUNTY ENGL*TEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESSj{ ' *Faip� t
FOR APPLICANT TO FILL IN LOCALITY
BUILDING
ADDRESS 7 &-� NEARROSSEST
ST
LOCALITY A
- �- � �� CDISTRIC7 N0. "SERIALNO. PERMIT N0.
NEAREST _, h Pi s ) S
CROSS ST.
�..� RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USEZONE OCCUPANCY
-ADDRESS BK� j " v I I BK PG
CITY TELAO.
CONTRACTOR CO.IMP.N0. `I
ADDRESS j " :', '1 < t j, __ JOB N0.
CITY TEL.NO. TRUNK PERMIT NO.
°Y i7 a` STATE '
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. J PERMIT NO.
BLOCK I TRACT INDUSTRIAL
WASTE APPROVAL
N0.OF BLDGS.
SIZE OF LOT ZS- 3 NOW ON LOT CHARGES
USE
BUILDINGS ' CONNECTION CHARGE FEE
,�, 4`y
NO. DESCRIPTION OF WbRK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BX,
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
_ T ----.".._...__.._.._.-.-_— N0.
ALTER OR REPAIR EXISTING DATE I BY
_SEWER OR DISPOSAL SYSTEM 1.00 f
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAE
PITS AND/OR DRAINFGELDT OR 2.00 STATION v DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00MAN`PP REFERENCE
..
_ PERMIT_ $ TYPE OF CONNECTION' LI NGTHPFROM
Y. CURB P.L. M.L.TO .L
OWNERS .
QO
AUTHORIZATION 1� TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-----::1.__..DAY OF......._t Fes.................19..._-:°" NEW HOUSE SEWER
iWNER OR jf�rt tf CONNECT ADDITIONAL
OWNERS AGENTI, .1E .. C _ BUILDING OR WORK
ADDRESS y'� ...i _ SEPTIC TANK,SEEP.PIT(S)
/ C$<Lt�M.pt�.•� - �- + `; AND/ORDRAINFIELD
CAITHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-'� CESSPOOL ElDRYWELL C]ION AND STATE THAT 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 _
I HEREBY CERTIFY THAT IAM 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 DESCRIBE�Rv,RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(]
SEEP.PIT(S)C] CESSPOOLS
SIGNATUREL L �-le'
OF PERMITTEE - ..--_- ---- --- ....._. _.... ............-.......
76A642A 663 7/53 ,