HomeMy Public PortalAbout4933 PERSIMMON AVE_Sewer__ 76AS42D
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.6-60 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION A,D,"A's's, 1 pe 0 ilmon -k-ve
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN.Supt of Building LOCALITY El Mprfte,
NEAREST
FOR APPLICANT TO FILL IN CROSS ST, Lower Azusa
LEGAL
DESCRIPTION LOT 140. 00, of OWNER T J . Craip,
BLOCK Tj` TRACTMAIL
4 DDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 2 CITY TEL.NO,
USE OF
I!UILDINGS i�es, and Gar DIS GROUP MAP PR ESSED BY
BK PG
CONTRACTOR
Sq u,
ire Dea'�'_ Selv,er Service
DISTRICT 0,)E
'5T--'-C-T
ADDRESS 2933 "14axsor, l3bi. CONNECTION DATA
T
CITY TEL.No. GI !,-2020 STATION DEPTH
STATE N OLE R UPPER
REGISTRATION NO. 2 88 rc) COUNTY MANHOLE REFERENCE
NO, DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3= 00 TYPE,I
TYPE OF CONNECTION-- LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y
PITS AND/OR DRAINFIELD $3.00 Y. CURB P.L�_ M.L.TO P.L.
OVERFLOW SEEPAGEYPIT
WeLORAINFIEL
EXTH.-CE'SPOOL,D L,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOC.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 IMP.NO. z�_ O_B NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
--WORK TO HOUSE SEWER $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00
—PERMIT NO.
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNER'S PERMIT p oo CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 5 00 REIMBURSEMENT FEE
.1 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 THISDAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_,._—__ BUILDING OR WORK
ADDRESSSEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT 'THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRTWELL[I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. FACKFILL SEPTIC TANKP50
SIGNATURE SEEP,PIT(S) UCESSPOOLS
[3
OF PERMITTEP
-VALMATION ROBERT A.WOOD
A x.., X.0. cAsx STJPERVISINO MECHANICAL KNOINEER
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