HomeMy Public PortalAbout4927 SERENO DR_Sewer__ R"Jo INIERIi
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Ya APPLICATION FOR PERMIT
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A OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGDYEER - -
BUILDING AND SAFETY DIVISIONBUILDING
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USE OF
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ADDRE AD CONNIECTION DATA
CITY L NO STATION DEPTH
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NO 11DEESCRIP I OF O FEE
PUBLIC EWE RCONNECTING TO f3 00
TYPE OF ION LENGTH FROM
SEPTIC T NK SEEPAGE PIT OR T U P L Y L TO P L
PITS_. R DRAINFIELD op SII 00
OVERFLOW SEEPAGE PIT DRAINFIELO
X P O VW L 2
HOUSE SEWER CONNECTING TO P C NO
RVA 1 p S T I CO IMP NO JOB NO
CONN TO HOUSEIONW LRB LOG OR TRUNK PERMIT NO ROAD PERMIT NO
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T EPAIR OSSREEABEANDOX HOUSE STATE ENCROACHMENT pl
00 PERMIT NO
INDUSTRIAL
_ WASTE APPROVAL
CHARGES
OWNERS PERMIT 2 OO CONNECTION CHARGE PEE
AUTHOHMATION TOTAL FEP REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE JINSPEC;qRSqIGKATURE
TO THE PUBLIC SEWER
SIGNED THI AlOF +B_ NEW ROUSE SEWER
OWNER OR CONNECTADDITI ON
AL
OWNERS AGENT BUILDING OR WORK
ADDRESS. SEPTIC TANK SEEP PIT())
AMD/OR GRAINFIELD
1 HEREBY ACKM LEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPU CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM fAt
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BT LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED REBID TIAL PROPERTY BACKFILL SE C TANKS
SIGNATURE SEEP PIT D CESSPOOL)
OF PERMITT
mF VALIDATION ROBERT A WOOD
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