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HomeMy Public PortalAbout4913 PERSIMMON AVE_Sewer__ DEPAUTIUENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL, DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION `d�'o 9 COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS !!�i /"? FOR APPLICANT TO FILL IN LOCALITY /,5z ©�r1� BUILDING NEAREST ADDRESS C. CROSS ST. // sdf LOCALITY DISTRICT NO.. SERIAL N0. PERMIT NO. CC NEAREST y� ► r A �+ yo Ci J CROSS ST. ' 7`IZ C d1:-'�."—d-�-/,./.r`� e RECEIVED BY Ready for Inspection DATEISSUED OWNER MAIL 1, } USE ZONE OCCUPANCY MAP ADDRESS � ,,^mai 6K PG CITY TEL.NO. CONTRACTOR �'. .,. _. - CO.IMP.N 0. ADDRESS jy C 10B NO. CITY ? ( i' { _ TEL.NO,,.;, o TRUNK PERNItT N0. STATE REGISTRATION NO. COUNTY ROAD PERMIT N(k, LEGAL DESCRIPTION LOT NO. � ,j-7 y t+- ., v STATE ENCROACHMENT � PERMIT N0. BLOCK TRACT.- INDUSTRIAL WASTE APPROVAL SIZE OF LOT — N0.OF BLDGS. NOW ON LOT CHARGES USE OF Y rf BUILDINGS CONNECTION CHARGE FEE N0.1 DESCRIPTION OF WORK FEE — — HOUI REIMBURSEMENT FEE.` SE SEWER CONNECTING TO PUBLICSEWER @ $ 3.60 RECEIPT N0. , !NE I BY HOUSE SEWER(CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.ORO r` EXCEPTION RE RDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO DATE` 18Y SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR ----` PITS AND/OR DRAiNFIELD 2.00 STATION +" CESSPOOL—DRYWELL ,► ).,_7 DEPTH —SPECIAL CONDITIONS ONLY 2.00 MANHOLE i4EFERENCE ^UPPER t ""r" _ TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT I Y CURB P.L. M.L.TO P.L. AUTHORIZATION TOTAL FEE --- — I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTII;N�G/ APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING THE.PUBSEWER SIGNED THIS_.=_ DD AY OF_--/;./al?-- NEW A 19�`� CONNECT HOUSE SEWER EIS TIONAL OWNER OR BUILDING OR WORK OWNERS AGENT&Jc'- EPTIC TANK,SEEP.PIT(S) ADDRESS ---............ __..._._. _._ AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL I] CAT IONAND 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 1 AM 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFIILL SEPTIC TANKS � SIGNATURE SEEP.PIT(S)E] CESSPOOLS OF PERMITTEE­­..------_------------ ` _._.....-•-- 76A642D 663 1/53 DEPAUTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL-, a DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION ` U COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS t FOR APPLICANT TO FILL IN LOCALITYBUILD NEAREST ADD EISS ( - —---- — CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST -- — A S CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL ADDRESS �^ USE ZONE j OCCUPANCY MAP -- ----— I'J BK PG CITY TEL.NO. CONTRACTOR _ _ _ CO.IMP.N0. ADDRESS JOB NO. r CITY TEL.NOIJI'jol�j J—Fio4 -- TRUNK PEF#11(JT NO. � , ATE REGISTRATION NO. -t ,,CDESTUNTY ROAD PERMIT NO, LEGAL DESCRIPTION LOT NO.STu,S/ tP}f6 T, STATE ENCROACHNT . �, � U BLOCK TRACT� PERMIT NO. z INDUSTRIAL t� WASTE APPROVAL SIZE OF LOTd J. Z X J�jJ$"' NLIO BLDGS. // �L( NOW ON LOT ' HAR S USE OF BUILDINGS "' •e; CONNECTION CHARGE FEE N0. DE:SCRIPTION OF WORK FEE REIMBURSEMENT FE HOUSE SEWER CONNECTING TO _ ! PUBLIC SEWER @ $ 3.50 L. RECEIPT NO. I 0 TE I BY { HOUSE SEWER GONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RE ORDED WORK TO HOUSE SEWER 1.0_0_ ALTER OR REPAIR EXISTING NO• I DATE. 2Y 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 GRAINFIELD 2.00 STATION DEPTH CESSPOOL—D RYW ELL _SPECIAL CONDITIONS ONLY 2.00 _ MAN IOL'E REFERENCE Z P P ER," tplre4► Y. TYPE OFCONNECTION—ECTIONP.L. +`+—LNGTH MEL.TO PFR OM OWNERS PERMIT $ 1 00 AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE UBLIC SEWER SIGNED THIS.. SAY OF4'. .4--2C—.-......_.....1 5c/ NEW HOUSE SEWER OWNEROR �Id�, �J}L CONNECT ADDITIONAL OWNERS AGENT. ...... -.t..f ... .......--.. BUILDING OR WORK EPTIC TANK,SEEP.PIT(S) ADDRESS l .. -.. '. �..........----.. AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 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 i AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LO„ ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OFCALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S) CESSPOOLS OF PERM ITTEE-c',- -.-----....---------------------- V ..._.......... 76A642D 663 1/53 ;° aV IS&E-66g 3.315MPPLICATI N FOR PERMIT' t� •se; DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County Of Los Angeles BUILDING ADDRESS j^'!� WM.J. PDX,COUNTY ENGINEER —�-',-'--R�- �-- CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY �L FOR APPLICANT TO FILL IN NEAREST c CRESS 57� LEGAL -�- DESCRIPTION LOT NO, OWNER - Al BLOCK TRACTi MAIL OF LOT NOW ON LOT ZE NO. OF BLDGS- J/ tCITY Tei. NO. __sin OF BUILDING5_ -,.., .�' - r _ DISTRICT NO. G".OUP i MAP G BK PG CONTRACTOR ADDRESS CONNECTION DATA - CITY TEL. NO. STATION DEPTH L7 STATE MANHOLE REFEP, CE _ R_UPPE REGISTRATION NO. 1:1 COUNTY - —�.. ��-,__--- _ LOWER . NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH rR06i i-- HOUSE SEWER CONNECTING TO Y CURB P. TO P.L. _ PUBLIC SEWER @ $ 5.50 _ -- ---- - G HOUSE SEWER CONNECTING O — PNIVATE D SPOSAL SYaTEM L..00 ---- --- - --- --.--- --- CON^lECT ADDITIONAL BLDG. OR J I..A,� P C N0. OR. TO HOUSE SEWER 1.00 r � -- CO. IMP. NO. ---�---�J6B N_0..---- ALTER OR REPAIR_ EXI TINGSE'dJER OR D.SPOSAL SYSTEM 1.001— TRUNK. P' MIT NO. ROAD PERMIT NO. ..� DISCONNECT AND ABANDON SEWER.:�.— — ST�FNCROACHMENT AND./OR DISPOSAi SYSTEM _ 1_.00 — PE IT NO, SEPTIC TANK SEEPAGE PIT OR A� MTS AND/GR DRAINFIELD ^— .GO INDUSTRIAL CESSPOOL. DRYWC L --- —`---" "—' WASTE APPROVAL --- SPECIAL CPNDITIONS ONLY 2.00' II CHARGES I - illi CONNECTION CHARGE FEE -�- ✓�, g,'�i',Av f �� OWNER-s PERMIT 00 -------- AUTHORIZATION - .-AUTHORIZATION TOTAL FEE � RE1M1sf u115E1 Ent FEE i 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR, TO CONNECT THE ABOVE DESCRIBED EXISTING DWELL ING AP O 13 �� TO THE PUBLIC SEWER _" - .. .. ""'_' —'"--. -----' NEW HOUSE SFW--R ' SIGNED THISa__.__DAY OE— _ 19_ OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK -�_ SEPTIC TANK,SEEP, PIT(S)���—� AND/OB I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DR.YidELL l.a AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .?YITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS SW.AGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HO_USESEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS M SEEP. PITS) Q CESSPOOLS L,] —_ SIGNATURE @ P,�'.- -'N OF PERMITTEE WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR