HomeMy Public PortalAbout5008 PERSIMMON AVE_Sewer__ DEPAIVUVIENT OF COUNTY ENGINEER SEWED-.SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS
• FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 5008 sPerSi=an Ave, CROSS ST.
LOCALITY E1 Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A J
CROSS ST. (;r$Yi( /iyA. ge Ft•P.P.1 `-s't,
�i
RECEIVED BY Ready far IRspectioo DATE ISSUED
OWNER POLO McNutt
MAIL
ADDRESS 272-1 San Gabriel Blvd. USE ZONE OCCUPANCYMAP
CITY San Gabriel TEL.NO.AT 94364 � I BK PG
CONTRACTOR LOO, Lid it', CiOIV'S UOTION 00, CO.IMP.N0.
ADDRESS 408 Winthrop 23r,,
10B NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 Ci 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 62STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
1NO.OF BLDGS. WASTE APPROVAL
SIZE OF LOT NOW ON LOT CHARGES
USE OF
BUILDINGS 1 Ee$— CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 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- � DATE I 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/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER 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
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS..........e.........DAY OF....... ......__....................19-._.-- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-.---......-...........----....................-._. ----•-- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS------------------------------------_-- --------•-•----•--•------•--- AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL 11
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 THATRE AM PROPERLY ES COERED DISCONNECT PLUG AND
AND/ST LICENSED IF REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SIGNATURE SEEP.PIT(S)[] CESSPOOLS El
OF PERMITTEE__.._'.__..---- -- =
76A642D 663 1/53