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HomeMy Public PortalAbout4932 PERSIMMON AVE_Sewer__ DEPAMMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL ' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 34051 COUNTY OF LOS ANGELES WILLIAM J. FOX. COUNTY ENGINEER BUILDING ` ADDRESS 119.3a FOR APPLICANT TO FILL IN LOCALITY 'EL JL10Nlf_ ADDRESS 4992 Persimmon St. CROSSST. LOCALITY EZ M rite a DISTRICT NO. SERIAL,NO. PERMIT NO. c NEAREST f A S 3 Z76 P CROSS ST. RECEIVED BY Ready for Inspection. DATE ISSUED OWNER S. $e Garcia MAIL ADDRESS S'am• USE ZONE OCCUPANCY MAP BK PG CITY TEL.NO. ,n — ...: CONTRACTOR r' `onul a Selarer 0011St.rd a CO.IMP.NO. ?Lr ADDRESS I Colt-.grove-Ave, JOB NO. CITY Montebello TEL-NO-UNion 1--504.8 TRUNK PERMIT STATE REGISTRATION NO.. 104445 S�. NTY ROAD PERMIT NO. LEGAL h f DESCRIPTION LOT N0. STATE ENCROACHMENT � L8 PERMIT NO. BLOCK TRACT (jmZ INDUS RIALWASTAPPROVAL SIZE OF LOT p N6-OF BL(/ / [.! NOW ON LOT 3. ARGES USE OF BUILDINGS Re s o CONNECTION CHARG EE NO. DESCRIPTION OF WORK FEE HOUSE SEWER'CONNECTING TO REIMBURSEME FEE PUBLIC SEWER G $ 3.50 ' RECEIP 0. 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 ( 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 PITSA'ND/ORDRAINFIELD 2.00 STATION �� DEPTH CESSPOOL—DRYWELL SPECIALCONDITIONS ONLY 2.0041 r 0& MANH�OLSEREFERENCE LOWER TYPE IfFrCONNECTION LENGTH FROM i rI OWNERS PERMIT $ I 00 r' P.L. M.L.TO P.L. 7 AUTHORIZATION TOTAL FEE 4 50 I HAVE THIS DATE. CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO T E .USLIC SEWER SIGNED THIS...~ _ _-_19 NEW HOUSE SEWER t�n�re'rC•� f.2's" OWNER OR - y'r �t CONNECT ADDITIONAL OWNERS YY..___...__..... ._ BUILDING OR WORK .ADDRESS_.....___...L_.. __ �.....r��............... —'__. - SEPTIC TANK.SEEP.PIT(S) -- - - - AND/OR D.RAINFIELD. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL EI CATION AND STATE THAT THE ABOVE.18 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 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 DESCRIBE RESIDENTIAL PR PERTY. BACKFILL SEPTIC TANKS E] f SEEP.PIT(S)E] CESSPOOLS©- /+ - •j OF PERMITTEE__d1 ! J r- -r. _._ 70A642D 663 1/63 /�