HomeMy Public PortalAbout4965 PERSIMMON AVE_Sewer__ aoAPPLICATION FOR PERMIT
2D D
8A 642
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
.BUILDING AND SAFETY DIVISION BUILDADDREING G � �; Pr
JOIN A, LAMBIE, Ceunty Enginear
WILLIAM! A. JENSEN, Supt of Building
_ LOCALITY �.
NEAREST
FOR APPLICANT TO FILL CROSS ST. 4v—,
DESLEGAPL LOT N0. a41 OWNER1--t14
MAIM. � � ,.BLOCK TRACT ADDRESStll OF
SIZE OF LOT NOW ON LOTS , CITY sp ✓ T
USE OFNGS� �_ DISTRICT NO. GROUP MAP PR CESSED BY
BUI - ..�+ K Pe
CONTRACTOR
ADDRESS' S ' , .� CONNECTION DATA
CITYY TEL.N0. '% ST ION S DEPTH
STATE MANHOLE REFERENCE L UPPER
REGISTRATION NO. COUNTY
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CO .N N LENGTH FROM *
PITS AND/OR,SEEPAGE PIT OR @ $3.00Y. P.L. M.L.TO P.L. !X-
OVERFLOW SEEPAGE PIT,DRAINFIELD R }
EXTN..CESSPOOL.DRYWELL R S2.00 n
HOUSE SEWER CONNECTING TO PC.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB N0. CJ
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1.00
ALTERW R 6tIR AL5AYNDEM HOUSE @ $1.00 STATE ENCROACHMENT !—
SEWVPERMIT NO. LUU
.INDUSTRIAL
WASTE APPROVAL td?
7. +� CHARGES z
OtisVVicr+ S PES $ 2 000 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE &V REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNETS THIS DAY.,OR 19T NEW HOUSE SEWER
OWNER OR '`�� , CONNECT ADDITIONAL
OWNERS AGENT, y - l BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.T17(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
.AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ® DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER 09
PLUMBING AND SEWERS,,-,, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTI ! AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQ ED Y LOS kNGELE COUNTY D STATE OF ABANDON.HOUSESEWER
CALIFORNIA OR AT AM THE`L OWNER F THE STATE
BACKFILLSEPTICTANKS ❑
DESCRIBED RES EN PROPERTY. _ SEEP.PIT( CESSPOOLS
,C]., a'' -°' "---
OF PERMIT"' " ,. f'` .-
' VALIDATI014---l "/ ROBERT A. WOOD
CK. ■,o. f'� SUPERVISING MECHANICAL ENGINEER
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AAPPLICATION FOR PERMIT
6B48421D D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Enainser ADDRESS
WILLIAM A. JENSEN, Supt of Building LOCALITY n
NEAREST _ ..
FOR APPLICANT TO FILL IN CROSS ST. r `
LEGAL
DESCRIPTION LOT NO. ref W OWNER
BLOCK TRACT
MAIL _
USEOF
" r / ADDRESSfilOF d
SIZE OF LOT NOW ON LOTS r CITY y �' TEL,A@--7-- C '�
OF
BUILDINGS w) - DISTRICT NO. GROUP MAP P CESSED BY
� ��II 14 P/6
CONTRACTOR - )) J
USE
...]
ADDRESS - ' L° j� r CONNECTION DATA.
CITY TEL.N0. ATION 6 DEPTH :t
fI
S ATE MANHOLE REFERENCE $ UPPER
REGISTRATION NO. I COUNTY 1-141
NO. 1 DESCRIPTION OF K FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Ca $8.00 TY P jDF CO E3 H FROM
SEPTIC TANK.SEEPAGE PIT OR Y. P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PST,DRAINFIELD
ERTN..CESSPOOL.DRYWELL $2.00 aZ
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM C $1.00 CO.IMP. N0. IOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. �--,Y f y I � j 9x
WORK TO HOUSE SEWER a Sf.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT - 0
SEWER Oft DISPOSAL SYSTEM @ $1.00 PERMIT NO.
F :` INDUSTRIAL
WASTE APPROVAL N
CHARGES Z
OVMR'S PERM CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE, AT THIS DATE A CONTRACT WITH THE HEREfV NiMED C -
T ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELL NG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
OWNER THIS—DAY O — 19� NEW HOUSE SEWER
OWNER OR ' CONNECT ADDITIONAL
OWNERS AGENTv BUILDING OR WORK
ADDRESS SEPTIC 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 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS .REGULATING ALTER,REPAIR,SEWER OR
PLUMBIN ANI)-"�ggEWERS, I SEWAGE DISPOSAL SYSTEM
I HER P,C ERTIFY THAT I AM PROPERLY R ISTERED AND/OR DISCONNECT PLUG AND
LICENSE 'A�QUIRED BY LOS ANGELES COU Y AND STATE OF ABANDON HOUSE SEWER
CALIFO !A THAT 1 AFI TH LEGAL AIV OF THE ABOVE
DESCRI ED THAT
PROPER BACKFILL SEPTIC TANKS
xr - C
SIGMA RE-"-'. .�,... - �� .Y �"'-. SEEP.PIT(5) ESSPOOLS..""."' - N. --- ---
OF P x'
VAIMATIOI°I.- ROBERT A. WOOD
CK. M.O. 'CASH SUPERVISING MECHANICAL ENGINEER
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