HomeMy Public PortalAbout5026 PERSIMMON AVE_Sewer__ DEPAIVICMENT OF COUNTY ENGINEER SEWER—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 5026-P�er'gj-zc1ti()Mn-Ave* CROSS ST.
LOCALITY V1, Monte DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST. Grand Ave• & Freer St♦ A $
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER prlsa McNutt
MAIL
ADDRESS h�l'] m� j �- l_4C;r USE ZONE OCCUPANCY BK MAP PG
CITY San 'abrielTEL.NO. LT 94364
CONTRACTOR L,-p. & ji[ l,,'OIVSEjUCTION Got CO.IMP.NO.
ADDRESS A-0-8-
Winthrop 16 JOB NO.
CITY Alhambra TELNO. AT 48315 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113615 C 42 COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 65 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17667 INDUSTRIAL
SIZE OF LOT N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 Res* CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
-i -- ---- -- REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
1 PUBLIC-SEW
SEWER 0 $ 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 ANO 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
C-'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
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
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL 1
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE t
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM 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 El
SIGNATURE SEEP.PiT(S)(-j CESSPOOLS
OF PERMITTEE--- ---- - -- .............
76A642D 663 1/53