HomeMy Public PortalAbout5633 PERSIMMON AVE_Sewer__ DEPARTMENT OF COUNTY MGM=
SEWER—SEWAGE DISPOSAL
DIVISION OF-BUILDING AND SAFETY PERMIT APPLICATION
COUNTY.OF LOS ANGELES
WILLIAIN'J. -FOXY CGUNTY-ENQINEER ' BUILDING
ADDRESS
FOR APPLICANT TO'ALL IN LOCALITY 7', ',
BUILDING NEAREST
ADDRESS 'y ��A�+l VP:°�I�iti kA CROSS ST.
LOCALITY DISTRICT N0. SERIAL N0. PERMIT NO.
CROSS ST. V L 0Are,
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OWNER 5,- . 61,1 �.h 1�,e I @ k ! �s� 2-V IYY
MAIL p USE ZONES OCCUPANCY BK MAdPG
ADDRESS h� ►Z`w bE
CITY7-1
i TELNO. /`7� I �
CONTRACTOR n fda�Illlii$Tt`I I J. a! i��i.t+;rs .C;�1�
CO.IMP.N0.
0933 N. CLOVEgLY AVE. -
ADDRESS JOB.NO.
e
CITY eM"'' TELNO.
TRUNK PERMIT NO.
REGISTRATION NO. ® COUNTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO.. PERMIT NO.
BLOCK TRACT t 5 as� WASTE AAL
PPROVAL t
SIZE OF LOT d!�OZAo NOW ON LOTS CHARGES
USE
BUILDINGS CONNECTION CHARGE F E
NO. DE5CRIPT ONOF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 "i RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /fXCEP41ON RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING I/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 ! d
--PITS AND/OR DRAINF•IELD 2A0' STATION DEPTH
_. DRYWELL
SPECIAL CONDITIONS,ONLY 2.00. IXANHOLE�REFERENCE OWE
!
TYPE OF COMNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 _ !CURB) +_El- 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' APPROVALS INSPECTOR'SSISNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_!��__DAX(OF. _ 19 NEW HOUSE SEWER YD ck a -Z�c-
OWNER ORZvbo
CONNECT ADDITIONAL
OWNERS AEw-� :. Y.--
ADDRESS
OR WORK
y'� SEPTIC TANK.SEEP.PIT(S)
ADDRESS..._.._ ._._._..�..;_ .�..r._ _�_:_ =_e.?�.. AND/OR DRAINFIELD
I 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE-SEWER
AND,
ND STATE OF CALIFO OR�THAT 1 AM THE - GAL OWN-
ER OF THE ABO 'D C i'l I W PI ERTY. ACKFILL SEPTIC TANKS °
■ n SEEP.PIT(S)[] CESSPOOLS ". )ISG ° '
SIGNATURE. i
OF PERMITTE
76A642A 663 ?/53 _ �� 5t