HomeMy Public PortalAbout4925 PERSIMMON AVE_Sewer__ 78A
&-668 Lf-55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. I_AMBIE, COUNTY ENGINEER ADDRESS
CASSATT U. GRIFFIN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN doss ST.
LEGAL - ..j, �., j ,. -✓ ..
DESCRIPTION LOT N0. -7 ;� _ �% --- OWNER_,,- ___ ---_------- ..
MAIL
BLOCK TRACT rev` r __;",�`✓_ ADDRESS � ,..;..._ _
_-i NO.OF BLDGS.
SIZE OF LOT/t R.t` _ NOW ON LOT CITY TEL, N0.
USE OF DISTRICT NO.. GROUP MAP
BUILDING5�r "y_ '~ 'i�✓4-__'-j-t_; - _- BK 'G
CONTRACTOR. -
CONNECTION DATA -
ADDRESS °� ,�� �.'.- T'" a✓:% '� .< G _._. -"- -- --- -..__
--
---
. STATION
EL. NO. x ✓ -.--� DEPTH
MANHOLE REFERENCE
STATE --zr- -•,-- ! �,._,,_ (L.rW R-
REGISTRATION N0. j COUNTY
NO. i DESCRIPTION OF WORK ----FEE _ -- -- --- - -- --
y I '{OUSE SEWER CONNECTING TO - TYPE OF CONNECTION LENGTH FROM
Y. CURB P L. M L.TO P L,
I
PUBLIC SEWER @ $3.50! .
SEPTIC TANS SEEPAGE PIT OR
PITS AND/OR DRAINFIELD __ (a). $3_.0.0
_ ER
OVFLOW SEEPAGE PIT, DRAINFIEL_-D — F. C. N0.
EXTN., ,V
_CESSPOOL,DRYELL,MAN_HOLE ((j) $_2_.00 CO. IMP N0. `: JOB NO.
HOUSE SEWER CONNECTING TO—
_____ ; PRIVATE DISPOSAL SYSTEM L $1.00 TRUNK,PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR -
STATE ENCROACHMENT
_VIORK'I'0 HOUSE SEWER----`-@ $1.00 PERMIT NO.,
— ALTER,REPAIR OR ABANDON HOUSE I INDUSTRIAL -
_—j _EWER OR DISPOSAL SYSTEM (af $t.00 .—_ WASTE APPROVAL
—�------"— — — —- - CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 40
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS J'TE i I N S P E C TO R's S I G N AT U RE____�__
TRACTOR TO CONNECT THE ABOVE DESCRIBED E%157iNG DWELLING i '
TO THE PUBLIC SEWER. NEW HOUSE SEWER 1
SIGNED TH[S DAY OF 19 - — ---- ---- ---
CONNECT AOCl710NAL
OWNER OR7 BU[LDING OR W
AGENT
OWNERS GEN7
SEPTIC TANK,SEEP,PIT(S)
.ADDRESS `r �' - , `" G : �::. AND/OR DRAiNFiELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS viR'!,.,4T16N
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TOCOMPLY CESSPOOL❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I�
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY- CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND J -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY. AND STATE: OF ABANDON HOUSESEWER -
CALIFORNIA OR HA;T I AM THE LEGAL OWNER OF THE ABOVE --- �-` ---...—
DESCRIBED RESIDENTIAL PROPERTY, rf BACKFILL SEPTIC TANKS El -
SEEP,PIT($) ❑ CESSPOOLS' "I
SIGNATURE --- - --- - �"'�- '- '-----------
OF PERMITTEEi,
1OHN A. LAM- , COUNTY'ENG I NEER VALIDATION ROBERT A,WOOD,CHIEF PLBG. INSPECTOR
CASA