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HomeMy Public PortalAbout5120 PERSIMMON AVE_Sewer__ DEPAIVrMENT 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 I'120 Par__ ©n Ave- CROSS ST. LOCALITY EI 11011t0 DISTRICT NO. SERIAL NO. PERMIT NO. NEARESTCROSS ST. (rand Ave• & Freer St• A RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL ADDRESS 272-1 San Gabriel Blvd, USE ZONE OCCUPANCY MAP CITY San GabrielTEL.NO. At 94364 ( BK PG CONTRACTOR T.f-1)a & f- CO NSMUM Tor 0g) CO.IMP.NO. ADDRESS 408 Winthrop Dry Alhambra AT 48315 JOB No. f CITY TEL.NO. -- TRUNK PERMIT NO. 113613 C 42 STATE REGISTRATION N0. COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. *ZZ STATE ENCROACHMENT PERMIT NO. BLOCK TRACT 17867 INDUSTRIAL NO.OF SLOGS. WASTE APPROVAL SIZE CF LOT NOW ON LOT CHARGES USE OF BUILDINGS 1B$r CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE 1 PUBLIC SEWER @ S 3.50 RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDQ.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER 0R REPAIR EXISTING NO. I DATE i BY SEWER OR DISPOSAL SYSTEM_ 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM I.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—ORYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER 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 APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC -SEWER SIGNED THIS.... .............DAY OF.......__-___......_.................19....... NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT.......-___-._---_------------..-......._.........................._......... BUILDING OR WORK ADDRESS......................._. SEPTIC TANK,SEEP.PIT(S) ...._.... AND/OR DRAINFIELD [ 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 E] SIGNATURE SEEP.PIT(S)o CESSPOOLS OF PERMITTEE.-........-•----- ..-_.:,..._-...... ---------- 76A642D 663 1/53