HomeMy Public PortalAbout4955 PERSIMMON AVE_Sewer__ DEPAN.TIN[ENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL�-
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 3 42 0 .1
` COUNTY OF LOS ANGELES -
WILLIAM J. FOX. COUNTY ENGINEER' BUILDING
,•. ;I ADDRESS
FOR ALPPLICANT TO FILL IN LOCALITY
ADDRESS �]��� `� /� NEAREST
. .Mrl A CR08S ST.
LOCALITY DISTRICT N0. SEIIIAL NO. PERMIT NO.
NEARESTA 3 9D F' J
CROSS ST. ► /(�{�►/!,
� REC VED BY Ready for Insoeation DATE 188UED.
OWNERP. P. �Q — �. .-?, 5--of
MAILSm-6
` USEZONE OCCUPANCY MAP
ADDRESS �1..A&�t BK PO
CITY TEL.NO. / I iA
CONTRACTocalif'ornia Sever Const■ Co. CO.IMP.NO. l!
ADDRESS 1317 Colegrove Ave. ,oBxo. /r
CITY Montebello TEL.NNN,lon, 1_5048 TRUNK'PERMITJO.
STATE
REGISTRATION NO.LO44+�rJ Sta.f:OUNTY ROAD PERMIT NO.
LEGAL DESCRIPTION LOTN0.X � STATEENCROACHMENT�
,r '� PERMIT'NO. !
BLOCK TRACTINDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BL
DRS.
NOW ON LOT
� CHAROES�
USE OF
BU1L'DIN68 CONNECTION C RGE FEE
N0. DESCRIPTION OF WORK FEE //
HOUSE SEWER CONNECTING TO REIMBU�BEMENT FEE
PUBLICSEWER @ $ 1:50 0 CEIPT NO. 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 STATION � � �/f DEPTH
CESSPOOL—DRY W E LL
SPECIAL.CONDITIONS ONLY 2.00 "' MANHOLE REFERENCE
J� �f �:UPRSR LOWER
TYPE OF ONNECTIONLENGTH FROM
OWNERS PERMIT $ •I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEEL�
I HAVE THIS DATE CONTRACTED..WITH. THE HERE N NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PLIC SEWER
SIGNED THIS..-% ....D �Y OF.....-. f�..�.:_ ...._.I NEW SI
OWNER OR CONNECT ADDITIONAL.
OWNERS
AGEAT r. . :._.. :. ~ ?sem.. ._. _ BUILDING OR WORK
ADDRESS. �r -�' � SEPTIC TANK.SEEP.PIT(S)
-.... -... ..._.....__............_......_.._.._.... - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL.[] DRYWELL
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
I HEREBY CERTIFY THAT I AM PROPERLY.REGISTERED DI8CONNECT PLUG AND
AND/OR LICENSED AS REQUIRED' BY LOS ANGELES COUNTY ABANDON HOPLUG ND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER.OF THE ABOVE DESC ED ESIDENTIA.L PR PERTY.. BACKFILL SEPTIC TANKS' �
F}�yy* / SEEP:PIT(S)[] CESSPOOLSS
SOF PERMRTTEEt _t—._ o�!!_. _-----_
7"BUD 00 1/53