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Home My Public Portal About4962 PERSIMMON AVE_Sewer__ 'E808 2/70, 6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL J DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING L D I JOHN A. LAMBIE. COUNTY ENGINEERAunRESs i�an 4-�W-ef_ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 0 �_V NEAR E A�.i S TF (:ROSS F R APPLICANT TO FILL IN CROSS ST. IPRINT OR TYPE ONILYi _DESCRIPTION LOT NO. OWNER MAIL 2 BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO, ;L,2 USE OF BUILDINGS D!STricTNQ. ['rROUPICLASS "AP PROCESSEE) By 8K P3 (�ONTRACTOR ADDR CONNECTION DATA CITY U(IIII N., STATION DEPTH `a TATE LIC MANHOLE REFERENCE LICENSE: N.0. CLASS LOWER NO. DESCRIPTION 0 WORK Per TYPE- OFCONNECTION LENGTH FROM OUSE CURB M.L.TO P.L. PUBLIC SEWER $5.00 ........ P . NO. SE FIT -11 �"T. R Ofl, E JOB NO, !NFIELO S10,00 CO�JMP4 NO. 4_ousE SEWER CONN_ECj�ING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE D;SPOSAI.SYSTEM $3.00 COPdNEC7 ADDITIONAL BLDG.ORAFFIDAVIT I *AIIER NO WORK TO HOUSE SEWER @ $3 00 OVERFLOWSEEPAGE PIT.DRAINFIELr) EXTN..CES SPOO. .DRYWELL,.MANHC)LE $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY�OR STWIDENING A _�,EWIEROR__DISPOSAL SYSTEM $3.00 TE ENCROACHMENT PERMIT NO, INDUSTRIAL WASTE APPROVAL CHARGES OVME MIT 3roo CONNECTION CHARGE FEE AUTHOMZATIONFTOTAL FEE -/Z.-d IHAV AT THIS DA7E A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR -7 - -7-�: R To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING --- _:� TO THE P OBLIC SEWER, APPROVALS _ j DATE lNf�P)ECYOWS51GNATURE SIGNED THIS DAY OF ____19_ _ _ OWNER OR NEW HOUSE SEWER 7, OWNERS AGENT—_—, CONNECT ADDITIONAL BUILDING OR WORK ADDRESS—___ SEPTIC TANK.SEEP.PIT IS) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL DRYWeLL I I Hr RE CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -ALTER:REPAIR,SEWER OR ;_iCENS SF EC'AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF WAGE DISPOSAL SYSTEM CALIFORN A OR THAT 1 AM THE LEGAL, AL. OWNER OF, AND INTEND TO -ONNECT IDE DES a S DISC PLUG AND RES IN THE ABOVE 'CR ED RESIDENTIAL IDENTIAL PROPERTY. ABANDON HOUSESEWER SIGNATURE r OF PERMrTTE BACKFILL P SEPTICTANKS IT(S) CESSPOOLS VALIDATION- JACK R. ALLEN CK. M.O. CASH SUPERVISING MECHANICA! ENGINEER -.4 CE808 12.-58 IEA 842D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FCROSS '�� v� JOHN A. LAMBIE. COUNTY ENGINEER .2'COLEMAN W. JENKINS, SUPT, OF BUILDING FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLOCS, t— SIZE OF LOT O ,� NOW ON LOT / CITYUSE OF JJr TEL. NO. „ BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY SK PG CONTRACTORr !* 4�✓LxYl q ADDRESS J G) r CONNECTION DATA ` CITY '� TEL. NO. 'Jq a Y'410 STATION DEPTH STATE , LIC UPPER MANHOLE REFERENCE LICENSE NO; CLASS LOWER NO. DESCRIPTION OF WORK FEE _ TYPE OF CONNECTION LENGTH FROM^ HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER IYS.00 "-'— —_-- — SEPTIC TANK,SEEPAGE PIT OR P.C.NO. CO.IMP.NO. .JOB NO. PITS AND/OR DRAINFIELD @ SIO.00 -- — -- --- HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM S9-00 ' I CONNECT ADDITIONAL BLDG OR I AFFIDAVIT I WAIVEREASEMENT RECORD.INSTR-NO. DATE G� WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT DRAINFIELD — j O EXTN..CESSPOOL.DRYWELL MANHOLE @ i5.00 I� -- - - - HWY.OR ST.WIDENING !RRlI.%14r7�dILABA NDUN HOUSE � SEWER SYSTEM $3.00 STATE ENCROACHMENT PERMIT NO. ---�-- - INDUSTRIAL �py ~ _ WASTE APPROVAL s ! `.; ,�' tL ✓ ,.� OWNER'S PERMIT _— s i _ z: oo ------r� --- CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE j Lr,-n --- ----------- _.—_ I HAVE AT THIS DATE A .CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO.,CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---TO THE PUBLIC 77;R- . ER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF �. 19— ---- - -- OWNER ORj �t NEW HOUSE SEWER OWNERS AGENT_'__.//_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS ! HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP !CATION SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER;REPAIR,SEWER OR LICENSED AS REQUIRED By LDS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM A CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO pISC ONNECT PLUG AND //yy RESIDE IN, THEjV�JF� DESCRIBED R .IDENTIAL PROPERRTY. ABANDON HOUSE SEWERSIGNATURE "'.... /' /e. / f :( �.IE<QF PERMITTEE /�'�f i/y BACKFILL SEPTIC TANKS ❑ SEEP.PITS) ❑ CESSPOOLS ❑ VALMATIO JACK R. ALLEN I CK. M.O. SUPERVISING MECHANICAL ENGINEER CAY SWH f 'x7232 : UCT19 10 D 5.0 0- A-445 DErAsTRaMNT OF aOUNTY EKGDI�• SEW ER—SEWAGE DISPOSAL DIVISION-OF $UMDINC AND. SAFETY PERMIT APPLICATION a8 oUNW OF LOS.ANGEL WILLIAM J. 'FOX,. COUNTY' ENSINEER t BUILDING it ADDRESS. LOCALITY FOR APPLI NT TO FILL IN -�' BUILDIN.O ��qj t ' NEAREST ADDRESS C2 r CROSS ST. J LOCALI r DISTRICT N0. Ready for Inspection PERMIT N0. NEAREST �� d 9 D� S Y/ CROSS ST. EFVFE:D Y DATE I IRS�UE�D BY DATE OWNER fal / cG1% !�" ' ,tip-G MAIL USE/ZONE OCC PANCY ,s BK MAP PG ADDRESS C.1/1/✓L.� v (� CITY__ __ TEL.NO.. e — .I r . COHTRACT010allf-Orrii a Sewer Const o CO® G - CO.IMP..NO. ADDRESS .3317 Cole-grove --Ave. JOB�NO.- CITY Mon'teb@110-- - TEL.NO. ` TRUNMeERMIT:NO. REGISTRATION NJ04445 StgEAT Y ROAD PERMIKNO. / LEGAL STATE ENCROACHMENT DESCRIPTION :LOT NO. �+ PERMIT NO'. BLOCK _ TRACT' INDUSTRIAL WASTE APPROVAL SIZEAF LOTNO.OF SLOGS. Q NOW ON LOT / CHARGES BUILD_INOS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE.SEWER CONNECTING TO REIMBURSEMENT FEE .PUBLI.0 SEWER S' 3.50 /RECgIPT NO. DATE BY HOUSE SEWER.CONNECTING TO l PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDS.•OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00. —ALTER OR REPAIR EXISTING NO. I DATE I.BY SEWER OR.D.ISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL.SYSTEM 1.00 CONNECTION DATA SEPT_ PITS ND/OTANKRDS AE FIELD T OR 240STATION J I '7 DEPTH f, CESSPOOL—ORYWELL SPECIAL-CONDITIONS ONLY 2.00 ,INA t-EgEFERENCE 6J UPREIL JAYM TYPE OF CONNECTIO � NGTH FROM OWNERS PERMIT $ I do Ye CURB P.L. �eM L.TO P.L. J AUTHORIZATION TOTAL FEE U I HAVE"•THISDATE CONTRACTED WITH THE HEREIN NAMED., CONTRACTOR TO CONNECT THE E ABOVDESCRIBED. EXISTING APPROVALS INSPECTOR'S SIGNATUREDATE DWELL-I:N.G TO THE UBLIC SEWER -= SIGNED.THIS. DA OF. .119i NEW HOUSE SEWER OWNER ORCONNECT ADDITIONAL OWNERS AOENTY. BUILDING OR WORK _ ADD•RESS...�. .' SEPTIC TANK,SEEP.PIT(S) AND/OR GRAINFIELD 1 HEREBY'ACKNOWLEDGE T T'1 HAVE READ THIS APPLI- CESSPOOL[3 DRYWELL E CATION AND STATE THAT T.HE ROVE IS.CORRECT AND AGREE TO COMPLY WITH.ALL COUNTY ORDINANCES AND STATE LAWS t ALTER.REPAIR,SEWER OR REGULATING PLUMBING AND.SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG.AND AND/OR 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 DESCR ED SIDENTIAL PROPERTY,. BACKFILL SEPTIC TANKS.❑ SIGNATURE .61 SEEP.PIT(S).[]CESSPOOLS OF PERMITTE= TM642D S&E663 4/64