HomeMy Public PortalAbout5188 PERSIMMON AVE_Sewer__ ' DEPARTMENT 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 5144 Persinnons Ave* CROSS ST.
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAEST
CROSS ST. Grand & Freer St, A S
�,�Ct,7�a'1YRECEIVED BY Ready for Inspection DATE ISSUED
.d1LL
OWNER poi• McNutt
MAIL
ADDRESS San Sa,n Gabriel Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY San Gabri81TEL.NO.
ti 94,364
CONTRACTOR L.p. & Me 0ONS2'RUCTION 00.
CO.IMP.N0.
ADDRESS 408 Winthrop Dr.
JOB N0.
CITY Alhambra TELAO. AT 48315
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113513 0 42 COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 'jf, STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17667 INDUSTRIAL
SIRE OF LOT N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT `�� CHARGES
USE OF
BUILDINGS 1 R@S• CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 RECEIPT NO. f DATE BY
HOI)SE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM IAO
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—DRYW ELL
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
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.PITS)
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
I 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKS E]
SIGNATURE SEEP.PIT(S)❑ CESSPOOLS
OF PERMITTEE.._. ---------- -.
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