HomeMy Public PortalAbout5220 PERSIMMON AVE_Sewer__ DEPAUTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF ]BUILDING AND SAFETY PERMIT APPLICATION
i COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 5-920 2ar9_J_=___Om. ,kava♦ CROSS ST,
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST A S
CROSS ST. Grand Ave, & 1''Z'@Cir Gti r
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER PrLr "` T21iti
MAIL
ADDRESS 27 (' br,�7 iii vrl USE ZONE OCCUPANCY MAP
BK PG
CITY San GabrielTEL.NO. AT 94364 f{
CONTRACTORL,]), & L^16 GO1GSt'RUOTION Co.
CO.IMP.N0.
ADDRESS 408 V-1inthrop Drr JOB NO.
CITY Alhambra TEL.NO., 48 TRUNK PERMIT NO.
REGISTRATION NO.113613 0 42 OUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 80 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
SIZE OF LOT N0.8F BLDGS. WASTE APPROVAL
NOW ON LOT Y. CHARGES
USE OF
BUILDINGS 1 ROS. CONNECTION CHARGE FEE
NO.' DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWERCONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER I."
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 E
DISCONNECT AND ABANDON SEWER
AHD/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
Urrtri LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I 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
I
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 1 HAVE READ THIS APPLI- CESSPOOL E] 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 REQUIRE
D 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 SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OFPERMtTTEE--- ---_..-.. .___.. --.-:_:
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