HomeMy Public PortalAbout4956 PERSIMMON AVE_Sewer__ DEPAItTJ1KENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 7
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1'
COUNTY OF LOS "GIMES
WILLIAM J. FOX. COUNTY ENGINEERBUILDING -
`-ADDRESS
FOR APPLICANT TO FILL IN CROSST
FOCALITY
BUILDING r . ' 8 .
ADDRESS J��
LOCALI DISTRICE%N0. SERIAL NO. PERMIT,NO.,
NEAREST A � GJ S
CROSS ST.
RE EIVED BY Ready for IneDeotion DATTFOfISS-)ED
OWNER
ADDRESB� - USoONE OCCUPANCY /BK MAP PG
{
CITY �,. TEL.NO.
CONTRACTOR1494-ele �
CO.IMP.N0.
ADDRESS A`-�� " JOB NO.
CITY TEL.NOz
TRUNK PERMIT NO.
REGISTRATION NO. d4 94;2 COUNTSTATEY ROAD PERMIT
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO: PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT NO.OF BL T WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE _
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
REIMBURSE NT FEE.
PUBLICSEWER $ 3.50 RECEIPT NO. DATE," BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 d
CONNECT ADDITIONAL BLDG.OR EXCE ON RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N TE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND'ABANDON SEWER
AND/OR DISPOSAL.SYSTEM. 1.00 CONNECTION DA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 (v STATION , DEPTH CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.06 MANHOLE REFER BICE
UPPER LOWER
' TYPE OF CONNECTIQN LENGTH FROM
OWNERS PERMIT ; 1. 00 Y. CURB .L. 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 INSPECTO SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS._.__-_...__.DAY OF.......__ _.....19 NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
OWNERS. AGENT..........-:......................._.-......_.................._. _ BUILDING OR WORK
SEPIC
ADDRESS..........._.......--.-....--.................... - AND/ORANK,S E.PIT(S) r
: m-
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
CATION.AND STATE THAT THE ABOVE IS CORP.ECT 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
AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS.ANGELES COUNTY ABANDON NOPLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE.ABOVE DESCRIBED RESIDENTIAL.PROPERTY. BACKFILL:SEPTIC TANKS
SIGNATURE `, $EEP.PIT(S)[] CESSPOOLS
OF PERMITTE .� ............................__.
70A642D 663 1/53
DEPA}ttriiENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL•
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION -,,�?a b
C0UNTY OF LOS ANGELES
WILLIAM J. FOX, CQBUILDINGUNTY ENCdINEER r 1
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYi'�/1" ,
BUILDING NEAREST
ADDRESS \} n r'1_ t 1-1..1'yi ��)' CROSS ST.
LOCALITY 4r�.Iv�T y DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA t S
CROSS ST. �}
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USEZONE OCCUPANCY MAP
ADDRESS BK PG
CITY -- —,- TEL.NO. � ..,
CONTRACTOR ^ (;C}; .C •. CO.IMP.N0.
, -5
ADDRESS �� ! ( � ' r-v'I_, JOB NO. i
CITY TEL.NO. iiiC;l - 04 Q
TRUNK PERMIT NO.
j� STATE
REGISTRATION N0. =i ss [) COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT' L.f INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT4_44 Q NO.OF RLDGS.
NOW ON LOT _ CHAR&ES'
USE OF " J'
BUIL07NGSCONNECTION CHARGE FEE '
NO. !DESCRIPTION OF WORK FEE
— ----- -- — — REIMBURSEMENT FEE
,6 HOUSE SEWER CONNECTING TO z
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. I DATE I BY
SEWER OR DISPOSAL SYSTEM1.00
D AS_EW
DISCONNECT ANBANDON ER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION /ig j- DEPTH
CESSPOOL—DRYWELL 1 _
SPECIAL CONDITIONS ONLY 2.00 s MANHOLE REFERENCE
Com..=8 LOWER
TYPE OF CONNECTIONLENGTH FROM - —
OWNERS PERMIT $ I DoY. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CQNTRACTED WITH THE HEREIN NAMED :
CONTRACTOR TO CONNECT THE. OVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.-_•. _: DAY OF-.-.• y NEW HOUSE SEWER
•- {�-•____-----19_-_-
OWNER OR " .{,�•/ �'
CONNECT ADDITIONAL
OWNERS APENl ..........._.- ....
......../' . ...... f BUILDING OR WORK
{3/ SEPTIC TANK,SEEP.PIT(S)
ADDRESS .----- --_--- ` - -. ---. _._.._-a AND/OR DRAINFIELD
CAITHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL E
ION 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 1--AM PROPERLY REGISTERED AND
DISCONNECT PLUG
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(�
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OFPERMITTEE.............`.....--------------••-•-•-......... ---------•---- --------
a
76A642D 663 1/53 y