HomeMy Public PortalAbout4938 PERSIMMON AVE_Sewer__ DEPAUfMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY3 4 0 6 1
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COUNOF LOS AWO=L PERMIT APPLICATION
WILLIAM J. FOX, COUNTY ENGINEERI BUILDING �/ ? P�
ADDRESS J
FOR APPLICANT O .FILL IN LOCALITY
BUILDING NEAREST ,-
ADDRESS /// CROSS ST. J"", //f,��v
LOCALITYa l DISTRICT NO. SERIAL NO. IPERMIT�NO. c
ST �� r A
CROSS
CROSS HT, r .F(�.-t.L4Gp' —RECEIVED BY Ready toy inspection DATE ISSUED
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MAIL /^..G USE ZONE OCCUPANCY MAP
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ADDRESS /�,,�t I I BK PG
CITY TEL.NO.
CONTRACTOR~ ,ruin Sewer Const.Co.
CO.IMP.N0. Ad
ADDRESS Colagrove Ave.
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JOB NO
CITY Montebello TEL.NWfNlon 1-5048 TRUNK PE NO.
REGISTRATION NO�..O444S Sti�00UNTY
ROAD PERMIT N0.LEGAL ,
DESCRIPTION LOT N0. ,466 t- _ fj�r ,j STATE ENCROACHMENT'
PERMIT NO:.
BLOCK TRACT WASTE APPROVAL
SIZE OF LOT 41,V NOW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION CNA FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEM T FEE
HOUSE SEWER CONNECTING TO �y
PUBLICSEWER G $ 5.50 O RECEI NO. 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- I 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
PITS AND/OR.DRAINFIELD 2.00 STATIONDEPTH
r.
CESSPOOL—DRYWELL 3
SPECIAL CONDITIONS ONLY 2.00 p , sS/a MANNOC"EFERENCE
aPPERd
f TYPE OFONNECTI w' .-/`LENGTH FROM
OWNERS
PERMIT $ 1 00 Y. CURB P.L. bo M.L.TO P.L.
AUTHORIZATION I TOTAL FEEa
I HAVE THIS DATE CONTRACTED WITH THE HER iN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS._._;.?.-...7_.DAY OF... f60� 1951/ NEW HOUSE SEWER y L- z*-3 5-;
OWNER OR CONNECT ADDITIONAL
OWNERS AG �. BUILDING OR WORK
ADDRESS.._ ....
_ SEPTIC TANK,SEEP.PIT(S)
..__ .__.._._._..__: ._ ...._._.._......__... .: ND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL[] DRYWELL 0
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND jOR 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 DESC IBED RESIDENTIAL PRO ERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(8)n CESSPOOLS
OF PERMITTEE.�� _.
7GA042D 663 1/53