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HomeMy Public PortalAbout4921 PERSIMMON AVE_Sewer__ aDEPAR N ENT OF COU'Yrg ENGMEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING ANTS SAFETY PERMIT APPLICATION COUNTY OF IAS ANGELES WILLIAM J. rOX. COUNTY ENuiNE:ER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING NEAREST ADDRESS rt'OSS ST. LOCALITY DISTRICT NO, ERIAL N0. j-PERMIT NO. j A S FdEARF : CROSS ST. RECEWED SY Ready for Inspection I VATE ISSUED OWNER MAIL USE ZONE OCCUPANCY MAP ADDR_E_SS CITY --. 13K PO TEL.W9,, CONTRACTOR CO.IMP.NO. ADDRESS JOB.NO, CITY TEL RO, TRUNK PERMIT NO. � REGISTRATION NO. _ 'COAD PEI'MIT NO. LEGAL zT:r E ENCROACHMENT DESCRIP`a ION LOT N0. BLOCK TRACT 4�fa kt. SIZE OF LOT NO.OF SLOGS. NOW ON LOT CIfAR_;yS USE OF -- - - - - BUILDINGS NO. I DEsER1PT°113N OR FEE HfiUSE SEWER GOIWNCTiNO TO - PUBLIC SEWER @ $ 3.59 i � RECEie ruH" i BY HOUSE SEWER CONNECTING T6 - -� �---F - - - - PRIVA E DISPOSAL SYSTEM 1.00 � 2 ! �j Gt9MtNECT iLDDITICP�d 4L I LUU.OR - - ��- 'i�XGEPTWN REC• lzBfD ALTSO REPAISE R WER mots ° I -- NO. �AT> !GV ALTER OR REPAIR EXISTING SEVER OR DISPOSAL SYSTEM I.Do -�DISCONNECT AND/OR DISPOSAL SYSTEM____ — I00_� - - CONNECTION EATA_ -,_�_.�- _.__ —ISEPTIC TANK SEEPAGE PIT OR - ; �PITS AND/ORDRAINFIELD 200 STATION DEF,; CESSP''pt-mDftYVCELI. -_..�-j r� SPECIALCONDITIONSONLY 2.00 MANHOLE REFERENCE - TYPE OF CONNECTION ENGTH FROM O'4/NERS � PEP_fIT� $ _ I GD Y, CURD � P,L rt.L,T0 P,L. AUTI-IORIZATIOIN T0TA L FEES _-- I HAVE THIS DATE CONTRACTED WITH THE HEREgN NAMED APPROVALS INSPECTOR'S SIGNATURE DATE CONTRACTOR TO ';'T T14E APOVE DESCRIBED EXISTING aiWELLING TO e9 ^'li!A SIGNEDt u r _.Ie NEW HOUSE SEWER C CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGF.. _ ».... .... _ .....a SEPTIC TANK,SEEP.PIT(S) ! ADORES a- AND/OR DRAINFIELD 1 HEREBYACKNOWLEDGETHAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWEL L 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 � I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED j AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS SIGNATURE �i SEEP.PIT(S)0 CESSPOOLS, j OF Pr RM5 T'EE -_----- ------- Te, 642A 663 /s APPLICATION FOR PERMIT - 7.-AG4�_D COUNTY COS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION 6CJ ILOADDRESS I NG �pqp . ;ry'dL]AY A. �.AMBIE. �.tllk:tlt''j EngineerI WILLIAM A. JENSEN, Sup"t of Bu lding L OC.ALITY NF.A.RcF'OR APPLICANT TO FILL IN CROSSSTDESGRIF'FiOIU 4477 NO. O W.dERnA NO. OF ©9_D:�>.St2E OF LOT NOWON I-OTL. NO. USE OF BUILDING% DISTRIC'_ NO. CSRo ;' MAP ROICE'..SSED BY CON,RACTOFB � y ADDRESS 6sONI4IECTTOt1'I BATA S CITY LL,. Nom^.. STA"'iO`Y DEPTH TV M9A�JHi� r @,Et.GFer ,fUE - LOWER._ R£C.7ST�2ATdON NO. .TA N'T)' - ND. DESGRIF !CS a O WORK FE Y :tiNscrir7N L.ENCTFi HOUSE SEWER CONN TINE'TO ;C _. ! ___-- Y U Ry r 1 PU BLfC SE P/ R @Sh p�j P S_ M.L C�P.L. ... . !SEPTIC TANKS SEEPAGE FT'-- OR gig PITS AND/OR DRA NF E D $iG UO GC_iM NO JOB N�. HOUSE SEWER t2 ONNF T NG 7'J' RW NK P33 R I C,^0 ROAD PERM t7 NO. a PR' PATE D POSA.L.SY EM G $3 00 ^r 1 p$ ,P�'SS c..ON NECT 40D7T.ONA 73 D" <'+.R _.- - AFFIDAV+T wn9vtiRX EPS:MEtd3 I FR E;rU D NST N0DATr Vw RK TO H E SEWER IV �,'q00 .= ��.. � lfFRl'LC7V 5 FA F�' 647 4 CFa P1F _- LI w EX)Ad Cr_5 OOt_.DfifYY L.L,MA'4HC1€_E AL A " -_ -.a— ____— -_— H`TIY..OR ST VVI"DEP Y i .3.}''+E Pf OR ARiA NDON HC\J`"E I SYSt— -.—__ _. STATE EWCHOAC'FiMG}iT /`•. PERMIT NO. WASTE 9'PRCIVAL , PERMIT $ 200 AUTHORIZATION TOTAL FEE CONNE ON CH.RCE FEE ..� 0ON7 I t{k.1'F_ AT -�}.{I5. .A'i E'. A REIMF? 175E F9EN1'F'>'=E CONTRACT WITH Fi THE 61 F.i�t :N !�P.rvl — --. ---_—__ ??ACTCR TO CONNECT ABOVE D€SCR BED 7X!�TiNG 0l, E@_L.!NC; TO THE -UPL 9FWrR. APPROVAL . �� BATE INSPECTORS SIGNATURE OWNER OR NEW HOSE SEV.- 4'Nh' R5 AGF:.N CO`VNEC ,ADDlT{ NA-I_ ADDft'S,SS..�,- BUiLOCNC OR WORK -.. _ � - SEPTIC TANK.5'EEF,1°IT I HERBY ACHNfJWLEDCIF THAT t HAVE REACD THIAPPL?CAYi0N SAND/OR pRAiNFiELD H AND S'I,,TC THAT T ABOVE 15 cCORt ECT AND AGREE TO c.OMPL.Y lt/R 9'HAv4. COJ Y C R:]iMAt:RC ES. AND 3 TT C. "SAW'S REGULATINGPLUM F3 HqG AND SEW F.RS. CLS$-00%. []. 'DR WELL � 1 _..- __ —. .___— _. 1' F{L RFBY CFR'IFY THAi I AM F'ROF'ERLY REGfS'i EREf3. AND/OR PL1_ r R., REPAIR,SEWER OR [ CEN SEC AS. EQUIR.ED 6Y LOS ANGLES COUNTY AND STATE OF. SEWAGEorsPO.SAL f'STE.7i ALIF'ORNIA OP FIAT i A T THV LEGAL OY NER OF AF O..INTEND TO _DI S�'-ON�RCO'T P.L.LiG AND- E.i I.Dc I.N. THU .ABYVE� + .R1'5E(D RES;.D NT,A.l_ PROPERTY. ABANDON HOUSE SEWER i S FJ ATLi,RE OF - SAC:KF!s SEPTIC TANKS I I F E'RMTTr _ —__ CESSPOOLS r � VALIDATION ROBERT" A. WOOD SUr,-_%,'SSIF>G MECHANICAL. ENGINEER CK, M.O. CA5H