HomeMy Public PortalAbout4905 PERSIMMON AVE_Sewer__ TUVIPLE' CITY
:1803 5-65 APPLICATION FOR PERMIT
?6AC,42D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A.LA%IBIE, Count, ngineer ADDRESS ___jj'9G
COLEMAN W. jLNKl,'\SI Supt. �f Building LOCALITY Temple City
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
DESCRIPTION. LOT NO
OWNER
MAIL
BLOCK TRACT ADDRESS 722 E. Valley Blvd.
O. OF BLDGS.
SIZE OF' NOW ON LOT CITY an "a TEL. NO.
USE OF
'ROUP PROCESSED
BUILDINGSRes. DISTRICT NO. G MAP D BY
BK PG
CONTRACTOR Square Deal Sewer Service
ADDRESS 2933 lfiaxson Rd. CONNECTION DATA
CITY El JYJon"Ue TEL, NO. 02 STATION 0 DEPTH
LICENSE LICE NSE
NO. 2.2 8 CLASS 2 MANHOLE REFERENCE —LOWER--
70
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRO
HOUSE. SEWER CONNECTING TO Y CURB M.L.TO P.L.
LIBILIC SEWER 5.00 00 P.C.NO.
-27" JOB NO.
"SE PTICTAWK- EE7P�G-E--PlT-0ff------f�------ CO.IMP. NO. (L
PITS AND'1111 DRAINFIELO $1 G.oo z�L-m 0
TRUNK PERMIT NO. ROAD PERMIT NO.
HOUSESEWERCONN
PRIVATEDISPOSAL SYSTEM 3.00.
EI OR -----Tj RECORD.tNSTR.NO ATE
CONNECT ADDITIO AFFIDAVIT WAIVER I EASEMENT
E SEWER O.
WORK TO HOUS 3.001
P-PWI-R LlffA�AJNb5N-H0j5-F--- --
-M
" $ 3.001 LU
SEWER OR DISPOSAL S'fSTF V
OYFA RTT=-- HWY.OR ST.WIDENING a-
EXT N L.
CESSPOO , MAN HOLE ct)
—-------- STATE ENCROACHMENT z
I FERCOLA'11ON TEST 5.0 I PERMIT NO.
INDUSTRIAL,
_WASTE APPROVAL
CHARGES
OWNERS---I---PERMIT-- 00 CONNECTION- - CH-
ARGE FEE
AUTHORIZATION I TOTAL FEE 71 QO
I NAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPE TOR'S SIGNATURE
SIGNED THIS—DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS--
SEPTIC TANK,SCEP,PIT(S)
IH HEREBY ACKNOWLEDQE THAT I HAVE READ THIS APPLICATION ANQ/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL [I DRYWELL Cl
IHEREBY CERTIFY THAT I AM. PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
*ALIFORNIA OR THAT I AM THE LEGA OWNER I AND INTEND TO
RESIDE
E NI L NT' DISCONNECT PLUG AN
ES DE IN, THE ABOVE DESCRIBED IES�110�ZENTI PROPERTY. ABANDON HOUSE SEWER__
SIGNATQRE
OF BACKFILL SEPTIC TAN
PERMITTEE
KS
❑
SEEP.PIT(S) CESSPOOLS 0!
,—VALIDATION
M.O. CASH
Lk;05 9 0 8Z8 NOV 18 1 0 D 7.0 ON
:E808 5-65
16A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION A. 8"""" -'V &/
-
101IN LANIIIJE. Count}' Vngiacer
coi,FNIAN k\. JKNKINS,Sup't. of Building [ ELOCALITY zf;,�
I NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
ADDRESS V*4,JF
lll NO. OF BLDG S.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
BUILDINGS DISTRICT NO, G MAP PRO"SSEP ZY
-1 BK PG
CONTRACT IT 2 f
ADDRESS 7 z CONNECTION DATA
NO, STATION DEPTH
LICENSE LICENSE r UPPER
-R
NO. CLASS MANHOLE REFERENCE
LC�WFR-
ocs7ewl PT-I oNl-oIF-W-0---RK---FEE---
TYPE OF CONNECTION LEN?T ErWV-'-
IROUSE SEWER CONNECTING T-0-- Y. CURb P.L. _t:To%
PUBLIC SEWER
$
P.C.NO.
E PTI PITS AND DRAINFIELD $1 PIT Ok __L.0
.0�0 CO.IMP.NO. --JOB NO. 0
HOUSE SEINECONNECTING- _ --' v
R -TG- TRUNK PERMIT,ble.-� ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $
.3.00 _
CONNECT 4 t�-D1 T I�YMAL BLDG OR FF�JAVIT WAIVER -EMEMENT RECORD. INSTIR.NO. DATE 0
WORK TO HOUSE SEWER $ 3.00
ABANDON HOUSE u
DISPOSAL SYSTEM $ 3.00
HWY.OR ST.WIDENING
EXTN.,CESSPOOL. MANHOLE $ 5.00
STATE ENCROACHMENT
PERCOLATION TEST $ 5.00! PERMIT
INDUSTRIAL
WASTE APPROVAL
RMIT
OWNER'S ECHARGES
j 211 00
CONNECTION CHARGE FEE
AUTHORIZATION VIT�,OTAL FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE PUBLIC S7!j,, APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY 0 19 OWNER OR NEW HOUSE SEWER
OWNERS A CONNECT ADDITIONAL
-�7BUV
ILDING OR WORK
.A�DDRESS
SEPTIC TANK,SEEP,PITS)
I HEREBY ACKNOWLEDGE THAT--THAVE-ReA. THIS
APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL [I DRYWELL ❑
I I
HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM. THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
OK
BACKFILL SEPTIC TANKS
�Y,�
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PER SEEP.PIT(5) CESSPOOLS
El
-VALIDATION
CN.
5 5 5 9- OCT 31 1 0 0 5.0 0-