HomeMy Public PortalAbout5120 PERSIMMON AVE_Sewer__ (2) DEPAI6T11IENT OF COUNTY ENGINEER SEVER—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 51 P�r31I)3YriOna 1k'{C4°.�. GROSS ST.
LOCALITY El XOnte DISTRICT NO. SERIAL NO. PERMIT NO.
CROSS ST. Grand Ave. & Freer St. A S
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER McNutt
�IC11ti
MAIL
ADDRESS 274- San. Gabriel Blvd• USE ZONE I OCCUPANCY MAP
` BK PG
CITY :Ian Gabriel TEL-NO. AT 94364 ff
CONTRACTORL,D, & g, CONSTUCTION CO.
CO.IMP.NO.
ADDRESS 408 Wintbxop Lr. -
�, JOB No.
CITY TEL.NO. Ski. I&QUi.4i
{X TRUNK PERMIT NO.
REGISTRATION NO. 113613 C 42 r]] COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 74 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT l CHARGES
USEOF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
BdUSE SEWER CONNECT-1
NO TO — REIMBURSEMENT FEE
PUBLIC SEWER @ S 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 8R REPAiR EXISTING NO• ( DATE (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 D_RAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
OFFER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PER
Y. CURB P.L. M.L.1'0 P.L.
MIT # I o0
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....---------..........................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 I HAVE READ THIS APPLI- CESSPOOL 0 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 n
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE------------------------ ------____.---•--
76A542D 663 1/53