HomeMy Public PortalAbout5126 PERSIMMON AVE_Sewer__ DEPAit'rMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL I
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN I LOCALITY
BUILDING NEAREST
ADDRESS 51$6 Nrgin-imnn A`a. CROSS ST.
LOCALITY El cS0nte DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST Grand Ave• & f're'er St• A S
CROSS ST. —
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P•L• McNutt
MAIL 272. Gabriel Blvd.
USE ZONE I OCCUPANCY BK MAP PG
CITY San Gabriel TEL.NO. AT 94364
CONTRACTOILOLo & Mo CON'STRUCT'ION COr
CO.IMP.N0.
ADDRESS 408 'vVinthrop Dr•
!OB NO.
CITY h=- ra TELAO.
TRUNK PERMIT NO.
E]XSTATE
REGISTRATION NO. 113615 C 42. COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO.7� STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
SIZE OF LOT NO.OF BLDGS. WASTE APPROVAL
NOW ON LOT w CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLICSEWER (!$ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 I
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- ` DATE ,BY
SEWER OR DISPOSAL SYSTEM 1.00 1
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
UFFEB LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION 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 GATE
SIGNED THIS....................DAY OF.............._..........._...........19... NEW HOUSE SEWER i
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
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
1 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)E] CESSPOOLS
OF PERMITTEE.---- -----::_:....-:. ...... ..:... .....1:.....
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