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Home My Public Portal About4929 PERSIMMON AVE_Sewer__ CE60811 APPLICATION FOR PERMIT 1 GL808 1 f-87 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING c JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Sup t of Building LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL - - DESCRIPTION LOT NO. -yr ;� OW:NER — BLOCKTRACT w e MAIL ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL.NO. USE OF �:] BUILDINGS_ _ DISTRICT N0, GROUP 1 MAP CONTRACTOR -- -- 7 BK PG ADDRESS CONNECTION DATA CITY TEL. NO. STATION DEPTH - STATE MANHOLE REFER CE UPPER REGISTRATION NO. - - ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ! - I :-bo- PUBLIC SEWER FIil $3, U TYPE OF CONNECTtOhr 9LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P. M.L.TO P,L. PITS AND/OR DRAINFIELD @ $3.0.0 _ __ OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO PRIVATE DISPOSAL SYSTEM_ @ $1.00 _ CO.IMP.NO. ``� JOB " CONNECT ADDITIONAL.BLDG.OR WORK TO HOUSE SEWER [ $1,00 TRUNK PERMIT NO. ,:r"'R0 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE r - SEWER OR DISPOSAL SYSTEM g $1..00 ( °; STATE ENCROACHMENT: PERMIT NO.. INDUSTRIAL WASTE APPROVAL _ CHARGES OWNER'S PERMIT S _I 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FES '" f REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING. APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER, - SIGNED THIS __DAY OF __ 1 g_,-: PffW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ BUILDING OR WORK SEPTIC TANK,SEEP,PITS) ADDRESS____ _ AND%ORDR_AINFIEL.D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND. AGREE TO COMPLY CESSPOOL❑ DRY_WELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pL.fI'R,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL WEROR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR — — -- — LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP, PI7(,S) ❑CESSPOOLS' y _ .. - _ — OF PERMITTEE I �F ;-='VALIDATION ROBERT A. WOOD CK. l M.C. CASH SLI ERVI$ING MECHANICAL,ENGINEER DEPAI TNIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY. PERM{7 APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING _ ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING ?' NEAREST — ADDRESS ° p _ CROSS ST. LOCALITY 1 \ DISTRICT N0. SERIAL NO. PERMIT NO. NEAREST- t A V c CROSS ST. I J RECEIVED BY Ready for Inspection DATE ISSUED OWNER f MAIL USE ZONE f OCCUPANCY MAP ADDRESSt'I BK PG CITY TELAO. CONTRACTOR CO.IMP.N0. ADDRESS JOS NO. CITY TEL.NA. ILII TRUNK PERMIT NO. STATE REGISTRATION N0. n COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. ; STATE ENCROACHMENT PERMIT NO. BLOCK — TRACT , INDUSTRIAL WASTE APPROVAL SIZE OF LOT 4 � / '"- NO.OF BLDGS. V / .0-- NOW ON LOT i CHARGES USE OF ?...r CONNECTION CHARGE FEE BUILDINGS �'�' NO. DESCRIPTION OF WORK FEE "— i HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER @ $ 3.50_ _ RECEIPT NO. DATE 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- DATE I RY 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 2.0 STATION 7 "? DEPTH CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 2.00 >y� MANHOLE REFERENCE - �� > is U FOF r- J LO W E R TYPE OF'CbNNECTION -LENGTH FROM OWNERS PERMIT I Cd Y. CURB P.L. `r M.L.TO P.L. AUTHORIZATION ' TOTAL FEE - 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 LIC SEWER y - i SIGNED THIS.-.... DAY OF_- IR'G.�"'----.• I9. .• NEW HOUSE SEWER OWNER OR ..' CONNECT ADDITIONAL L �` - BUILDING OR WORK OWNERS AGENT . _ 1 SEPTIC TANK,SEEP.PIT(S) ADDRESS--..... - Y---- ------ --- - AND/OR DRAINFIELD [ HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL DRYWELL CAT ii;N 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 DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP.PIT(S)[] CESSPOOLS SIGNATURE OFPERMITTEE_......-----------.._.......-......-........----r---. ----------------------- 76A642D 663 1/53