HomeMy Public PortalAbout5108 PERSIMMON AVE_Sewer__ DEPAUT COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION DING AND SAFETY PERMIT APPLICATION
CO LOS ANGELES
WIL.LIA , COUNTY ENGINEER BUILDING
ADDRESS
FO ANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDi ESS F,1, CROSS SL
LOCALITY C DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST S
�`C$C'S" e• A
CROSS ST.
RECEIVED BY Ready for inspection DATE ISSUED
OWNER
MAIL
ADDRESS n Gabriel Blvd, USE ZONE ` OCCUPANCY MAP
I BK PG
CITY i,lTEL.NO. -
CONTRACTORLs CO.IMP.N0.
ADDRESS 448 Winthrop Lr.r
J06 H0.
CITY �,lhaT1bra TEL.NO. 4T 48315
TRUNK PERMIT NO.
STATE
REGISTRATION COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 70 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17€ 67 INDUSTRIAL
SIZE OF LOT N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS l CONNECTION CHARGE FEE
NO.i DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO 1
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
--- ----- --
ALTER OR REPAIR EXISTING N0. ' DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 I
DISCONNECT AND ABANDON SEWER
AHD/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 2.10 MANHOLE REFERENCE
PER LOWER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 00
AUTHORIZATION I 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_................_-.._........._....._..I9NEW HOUSE SEWER
i
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT................__.........____------ ........ BUILDING OR WORK
SEPTIC TANKSEEP.PIT(S)
ADDRESS ----------------_------- AND/OR DIAiNFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE... ---- -------- ------ ------
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