HomeMy Public PortalAbout4906 PERSIMMON AVE_Sewer__ VAPPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of 'Los Angeles "a3ILDING
JOItIV A. LA!v1C31F, CouNry ENGINEER AD`DRE54 —
e, CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Z
NEAREST
bEscR PTION F APPLICANT TO FILL IN --- CROSS ST ,�,, 'y -
- --
.�- OWNER
__ ... - - -----
MAI' y
BLOCK TRACT @ �" - ADCRESS "�
k NO.OF BLDGS. CITY .l`q� %+' ` �`�'lr7EL. N0.
SIZE OF LOT r C NON!ON LOT ®`" 2 /jam%
CSSE.OF �+ DISTRLC N.O. GROUP ! MAP
PG
BUILDINGS ,/' r
CONNECTION DATA
STATION DEPTH fJ._ j,
CITY �.,� TEL. NO.�,� e'! ,✓!' -'- /- -- =--
` �MANHOLE REFERENCE •-`� �- � UPPER
,* r Q STATE
REGISTRATION N0. B' ,,, ❑ COUNTY -�- -
NO. I DESCRIPTION Or WORK FEE �---- -- –
I HOUSE SEWER CONNECTING.TO 01 TYPE OF CONNECTION LENGTH FROM
Y CURB P.L. M.L. TO P L.
PUBLIC SEWER (d $3..5.0 I '�'I „�-.';
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD r $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. NO. -
EXTN ,CESSPOOL,D YWELL,MANHOLE v COIMPN0OB$c.00 . , . T y JN0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYoT° ? (.i $
---1.00 TRUNK PERMIT NO, ROAD PERMIT NO:= s_
--`i -- E -----' ------ --
CONNECT ADDITIONAL.BLDG.OR _ —_--
1VORK 70 HOUSE S�lkER $t.OU - STATE ENCROACHMENT
-
-- TO -. SE - _----- 1.00 -- PERMIT NO, -------------------------- __-
ALTER,REPAIR OR ABANDON HOUSE - INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (y $1.00_ WASTE APPROVAL
—_ --------.�_---- ----------- CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT — 1 �00 -- --— ——----- -
--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE � ,� '
I HAVE AT THIS DATE A CONTRACT WITH THE HEREli7 NAMED CON- APPROVALS I DATE JINSPECTOP"SIGNAIURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING j
TO TFiE PUBLIC SEWER. ,,;� NEW HOUSE SEWER
SIGNED THIS ✓ DAY OF
19-ilCONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS ADEN V'L-6- -_:..� '>L..�'a v -SEPT- SE
�-- SEPTIC TANK,SEEP,PIT(S) j
ADDRk5S. —_ AND/OR DRAINFiEL.D-
' HEREBY ACKNCV,LEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOLn DRYWELLO
WITH ALL COUNTY ORDINANCES- AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
—---
1 HERESY CERTIFY THAT I ANI PROPERLY REGISTERED AND/OR --- --- -"--
LICENSED AS RFQU1RED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CAL'FORNIA OR THAT t A14 THE LEGAL OWN OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL >21PERXY. BACKFILL SEPTIC TANKS Lj
a y
SIGNATURE ��, - SEEP.PIT(S) L7 CESSPOOLS Ll1 -- -
- ' '... -- - -- -SSSS — — t-- - --
OF PERMIT'TE i
JOHN A.I.AMBIE.COUNTY ENGINEER VALIDATION ROBERT A. WOO( ,CHIEF PLBG. INSPECTOR
CK. I!,G. CASH V 4