HomeMy Public PortalAbout5202 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 K epa,4 ®.,,Ss taTt�• CROSS ST.
vT 'z
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO. rr
NEAREST A J
CROSS ST. Grand & 'Freer St•
RECEIVED BY Ready for inspection DATE ISSUED
OWNER prrZ• McNutt
MAIL
ADDRESS 272-i San Gabriel Blvd* USE ZONE OCCUPANCY MAP
I I
CITY San Gabrial TEL.NO. AT 94364 BK PG
CONTRACTORLQ. & gi, CONSTIIMOTION QQ, CO.IMP.NO.
ADDRESS 408 Winthrop Dr.
JOB N0.
CITY TEL-NO- AT 48315 TRUNK PERMIT NO.
STATE
REGISTRATION N0113613 ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 77 STATE ENCROACHMENT
PERMIT NO. -----
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL -
SIZE OF LOT N0.RF BLDGS.
NOW ON LOT 9 CHARGES
USE OF
BUILDINGS 1 g®S• CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 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 OR REPAIR EXISTING NO. I 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—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 Q0 Y. CU CB 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
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
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL E]
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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY D
ABANDON DISCONNECT HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- _
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)Ej CESSPOOLS El
OF PERMITTEE.:.:: _ ----------------...- .::... --------........:....
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