HomeMy Public PortalAbout5638 PERSIMMON AVE_Sewer__ APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS2rg ..
JOHN A. LAMBIE, County Engineer
Ca9MTT D. GRIFFIN, Sup't of Bufldia I
g LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. Jy OWNER ' L
BLOCK TRACT MAIL
NO.OF BLOCS. ✓ y
SIZE OF LOT NOW ON LOT CIS° f ' TEL.N0.
USE OF
BUILDINGSAl DISTRICT ]GROUP MAP PROCESSED BY
BK P6
CONTRACTOR
ADDRESS ' , ' CONNECTION DATA
CITY TEL.NO. STATION DEPTH
d y rTMP 1 r STATE MANHOLE REFIRING, _ y� UPPER
REGISTRATION N0. / .s ,.Ly COUNTY
NO. DESCRIPTION'-OF WORK FEE S��":� + SOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $3.00 TYPE OF CONNECTION L£NGT} RO'�
SEPT IC TANK, SEEPAGE PIT OR I YCURB P.L. M.I b P.L.
PITS AND/ORARA[tIF1ELD @ $3.00 - Y.
OVERFLOW SEEPAGE PIT.DRAINFIELD
ExTN_,CESSFOOL,DRY-WELL,NIANHOLE @ $2.00
I HOUSE SEWER CONNECTING TO P.C.NO.
i PRIVATE DISPOSAL SYSTEM @ $1.00 _ CO,IMP.NO.
p CONNECT ADDITIONAL BLDG.OR TRUNK.FERMI N0.. 4 ROAD PERMIT NO.
7 WORIt?0 HOUSE.SEWER jai? $1.00 _
AI.:TER,REPAIR OR ABANDON HOUSE STATE INCROACHjrf£`NT
SEWER OR DISPOSAL SYSTEM (P $1.00 PERMIT NO.
-PERMIT
WASTE A,.ty'ROVAL `'-
CHARGE
OWNER'S PERMIT $ 2 90 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
.. APPROVALS DATE INSPECTOR'S SIGNATURE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_. _-NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL -.
OWNERS AGENT BUILDING OR WORK f v
ADDRESS SEPTIC:TANK, SEEP,PIT(S) —
--._-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ^
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DP,YWEI.L C]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTYD STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER 0)y- THE.
DESCIUBED RESIDENTIAL PROPERTY.; BACKFILL SEPTIC TA.NKS[I
�' �: ✓.. r SEEP. PIT(S) CESSPOOLS❑
SIGNATURE ° I
OF PERMITTED
iF ,--,V DATION ROBERT A.WOOED
M.o. cAsx SUPERVISING MECHANICAL ENGINEER
211
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