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HomeMy Public PortalAbout5138 PERSIMMON AVE_Sewer__ DEPA2tTDtiENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 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 ADOREss .)138 PArAiMMn_n fk!Ze. CROSS ST. LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO. r NEAREST A S > CROSS ST. Grand .diver & Freer RECEIVED BY Ready for Inspection DATE ISSUED OWNER Pour McNutt MAIL 27 San Gabriel Blvd, ADDRESS USE ZONE I OCCUPANCY MAP i BK PG CITY ". Gabriel TEL.NO. �� ��a)� I( CONTRACTOR�r1�®�Clr L'flsiC, TE}NCo. CO.IMP.N0. ADDRESS 418 7 inthrop Dre 10B NO. CITY 111hambra TEL.NQ. AT 48315_ TRUNK PERMIT NO. REGISTRATION NO. 11361.3 0 42 � STATE ❑ COUNTY ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NO. BLOCK TRACT 17667 INDUSTRIAL ' SIZE OF LOT N0.OF BL NOW ON LOTOT -L WASTE APPROVAL CHARGES USE OF BUILDINGS 1 Res, CONNECTION CHARGE FEE NO.I DESCRIPTION OF WORK FEE �� HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE BY HOUSE SEINER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED ' WORK TO HOUSE SEWER 1.00 ALTER OR-REPAIR EXISTING NO• j DATE I 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 DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER TYPEOFCONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y. CURS 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......._----..-----r---...............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❑ DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR I REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I 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 SIGNATURE SEEP.PIT(S)o CESSPOOLS© OF PERMITTEE .._..w:i - --.-_-- ...e... ..._ I 7GA642D 663 1/53