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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-