HomeMy Public PortalAbout5020 PERSIMMON AVE_Sewer__ DEPARTUENT 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 rt��Q-BBY'.`3nI3 ,A17440 CROSS ST.
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. Grazed Lye s & Freer 8t.
RECEIVED BY Ready for Inspection DATEISSUED
OWNER P.TL Manatti
MAIL USEZONE OCCUPANCY MAP
ADDRESS 9721 San 'abri al R yd• - I BK PG
CITY $8.71_Lre311r.]Pj TEL.NO. AT 94.ri3
CONTRACTOR L.D. & M. CONSMUCTION CO,
CO.IMP.N0.
ADDRESS 408 ItYint<hrop Dro
JOB N0.
CITY Alhambra TEL.NO. AT 48315
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 rT COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT No. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 Rest CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE
1 HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE WSPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. 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 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB P.L.` M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 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..........................._........._t9..._... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._......_......_..... .--.... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S) I
ADDRESS....------------------_..--------------------..............................._.........._... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORD!NANCES AND STATE LAWS 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej
SIGNATURE SEEP.PIT(S)E] CESSPOOLS El
OF PERMITTEE::: .............
76A642D 663 1153