HomeMy Public PortalAbout5208 PERSIMMON AVE_Sewer__ DEPAWf1fMNT 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
ADDRESS6208 i,,,, ,w nve. CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
T9i 9-nte
CRss ST. Grand Ave & Freer St. A $
OWNER
PeLs MoNutt RECEIVED BY Ready for Inspection DATE ISSUED
MAIL 27� San Gabriel Blvd*
USE ZONE ; OCCUPANCY MAP
BK PG
CITY ,an ��+3,tS2`jelTEL.NO. AT 943rA 1
CONTRACTOR L0, & IA. CONSTRUCTION CO• CO.IMP.NO.
ADDRESS 408 ,Vinthrop Dr•
JOB NO.
CITY Alhambra TEL.NO. At 48315
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 a COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO.78STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT WASTE APPROVAL
CHARGES
USE OF 1eSr
BUILDINGS CONNECTION CHARGE FEE
NO.i DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER-I REPAIR-EXISTING NO• DATE lay
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 LOW€R.
TYPE OF CONNECTION LENGTH FROM
OWNERS ; I o0
Y. CURB P.L. M.L.TO P.L.
PERMIT
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
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL C]
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/0R 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)[] CESSPOOLS E]
OF PERMITTEE...
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