HomeMy Public PortalAbout4911 PERSIMMON AVE_Sewer__ DEPAI TRfENT OF COUNTY ENGIINEER SEWER-SEWAGE DISPOSAL y,�
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 3 2
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING rY
I ADDRESS
FOR APPLY 'NT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST. Z
LOCALITY DISTRICT aNO- SERIAL NO. PERMIT NO.
NEAREST A �� � ' S
CROSS'ST. e- 'r1d..e/11i.t,[.�.d.��
f „ J�ECF-IVEM BY, Ready for Insveetion DATEISSUED
OWNER
rVZtJ
MAIL •USE'ZONE OCCUPANCY MAP
ADDRESS BK PO
CITY TELAO.
CONTRACTORealif )xnia Serer Const—filo, eq.Im 7 N0. �rrrrr���••����•�``�'� �
ADDRESS -1317 Q-31e t'TOVB PVA.. io"CL. ¢�
CITY Montebello TEL.Nt�1�jDO TRUNK PER ITNO.
STATE �,•
REGISTRATION NOaQd.l, 45 StRISOUNTY, ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMEWT-"
PERMIT NO.
BLOCK F TRACT Loj- INDUSTRIAL.
WASTE APPROVAL
SIZE-OF LOT // NO.0 BLDGS:
IA NOW ON LOT a t' CHARGES
USE OF '
BUILDINGS _ CONNECTION.CHA..r°'RGE.FEE .�
NO. DESCRIPTION OF WORK FEE r�
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO �y� �•
PUBLIC SEWER $ S.5.0. —1,• �9 , RECEIPT NO. I DATE I 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. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION � � DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / �^' M UP FERENCE-31 s L
TYPE OF CONNECTI LENGTH FROM 7 �./
OWNERS
PERMIT $ 1 00 Y. CURB. P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE ` 4`
I HAVE THIS DATE.CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BLIC SEWE
SIGNED THIS..z ...DAY O ,�: .L?'11'� 19�? NEW HOUSE SEWER ,/,lysyl +�.� < •. '�'='
OWNER. OR
' ^� CONNECT ADDITIONAL
OWNERSGEN . . ,_ BUILDING OR WORK
/...1._.�. SEPTIC TANK.SEEP.PIT(S)
ADDRESS
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR HAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER ,
ER OF THE ABOVE DESCIPPIEDIR SIOENTIAL PROPERTY. BACKFILL SEPTIC TANKS
I SE
EP.PIT(S)C] CESSPOOLS
,, ar ;� „!i!
SIGNATUREE... ( i 5� -!J '`-
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OF PERMITTEh�:`.1...
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