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HomeMy Public PortalAbout5002 PERSIMMON AVE_Sewer__ DEPAICII'Y1(ENT OF COUNTY ENGINEER SEWED--SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES 1 WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING NEAREST ADDRESS 504+ 'P63!9j- JMC1M �Ve-► CROSS ST. LOCALITY F.1 Monte DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A S CROSS ST. u ; Grand Ave, & Freer St RECEIVED BY Ready for Inspection DATE ISSUED OWNERMAIL ►11► J�LC617 ADDRESS 27* San Gabriel Blvd. USE ZONE OCCUPANCY MAP BK PG CITY San GabrielTEL.NO. AT 94364 CONTRACTOR I+.D*& Ms CONS`.RUCTION CO* CO.IMP.N0. ADDRESS �„ 406 'Winthrop r. JOB NO. CITY Alb=bra TEL-NO- AT 48315 TRUNK PERMIT NO. STATE REGISTRATIOI_!9,(5613 0 42 COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. Ejl STATE ENCROACHMENT PERMIT NO. BLOCK TRACT 17867 INDUSTRIAL SIZE OF LOT N0.OF BLDGS. WASTE APPROVAL NOW ON LOT Z CHARGES USE OF BUILDINGS 1 CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER (p) j 3.50 RECEIPT N0. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED _WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. 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 DEPTH CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE -UP-ER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y. CURB P.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 INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS--------------------DAY OF................•............. 19....... NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT...--....................................--.................................. BUILDING OR WORK SEPTIC TANK,SEEP.PITS) ADDRESS - _...--..... - --------- - - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL© DRYWELL E 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 I HEREBY CERTIFY THAT 1 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEP'T1C TANKS E] SIGNATURE SEEP.PIT(S)EI CESSPOOLS OF PERMITTEE---------------------- ----- 76A642D 663 1/53