HomeMy Public PortalAbout5014 PERSIMMON AVE_Sewer__ DEPAlU MENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
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 5014 Perrsimon Ave. CROSS ST.
v
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST L1Onte A J
C
CROSS ST. tSrarf�3b� Rn M`r€aAZ� `i t.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. McNutt
MAIL
ADDRESS 2721 San Gabriel Flvdl USEZONE OCCUPANCY MAP
BK PG
CITY an GabrileTEL.NO. &T 94364 I+
CONTRACTOR Zwp. . C0LT3ZlTJ Tj04X C0@ CO.IMP.NO.
ADDRESS 408 llinthrop 'Dr. JOB NO_
CITY A TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. 111SIS C 42 17 COUNTY ROAD PERMIT N0,
LEGAL
DESCRIPTION LOT NO. Fj STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT lr�psry INDUSTRIAL
y l WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 2 CHARGES
USE OF
BUILDINGS 1 Rem. CONNECTION CHARGE FEE
NO.' DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 J 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-DRF-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/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 _ MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ i 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 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......_............DAY OF..............._.......................19.___.. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.....................-----__........._..................._.........._......... BUILDING OR WORK
_.__...-........................ SEPTIC TANK,SEEP.PIT(S)
ADDRESS_..-_
__.._..._..____......_.,.._......................_... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL(] DRYWELL
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 SEPTIC TANKS I]
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE... --------- - ------ _._-r:..:...-.
7GA642D 663 1/53