HomeMy Public PortalAbout5102 PERSIMMON AVE_Sewer__ DEPAIMMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY EN13INEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 510&ersimnon Ave. CROSS ST.
LOCALITY F-1 DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA S
p�
CROSS ST. � �—tG '€31 c; � RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. MaNUtt
MAIL
ADDRESS 2720 San Gabriel Blvd, USE ZONE OCCUPANCY BK MAP PG
CITY Sall B`dbrielTEL.NO. AT 94364
CONTRACTOR _Il_ & OONSMUOTjION CO. CO.IMP.NO.
ADDRESS 406 Winthrop Dr, JOB NO.
CITY Alhambra TEL.NO. 1 5
TRUNK PERMIT N0.
STATE
REGISTRATION N0. 1 1 3C�1'3 C 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 69 STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 17867 INDUSTRIAL
SIZE OF LOT NO.OF BLDGS. WASTE APPROVAL
NOW ON LOT ` CHARGES
USE OF
BUILDINGS 1 Res. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE --
HOUSE SEWER CONNECTING TO - REIMBURSEMENT FEE
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. � DATE +BY
HOUSE SEWER CONNECCTINO 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 1.80
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
ut'?ER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS Oo
Y, CURB P.L. M.L.TO P.L.
_ PERMIT ; 1
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___ OF-_--............................._.....19NEW HOUSE SEWER �
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT,--•_-------_------------------...................................._......_ BUILDING OR WORK
ADDRESS-----._____-----------.. SEPTIC TANK,SEEP.PIT(S)
---................-----------_-_--.-.........._...,.__- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL E]
CATIONAND 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 IAM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)o CESSPOOLS
OF PERMITTEE-- --^-------------
• - _••- - '_..._
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