HomeMy Public PortalAbout4928 SERENO DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
blviSION OF BUILDING AND SAFETY { PERMIT APPLICATION
COUNTY OF LOS ANGELES /
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
5�928
ADDRESS
FOR (A�PP)UCANT TO FILL IN LOCALITYBUILDING
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ADDRESS y9 Z p /)�C/t.+vty� ,�/L,_ CR088NEAREST 2!tl
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LOCALITY DISTRICT 0 SERIAL NO PERMIT NO
NEAREST :J A S
CROSS ST
flEC IVE BY Ready firlmOlLliw DATE ISSUED
OWNERp IVa-C4
ADDRESS y / y���(�[.ra.�-��/� U U OCCUPANCY 13K MAP ra
CITY42K TELN0. E
CONTRACTO M-C N i gb2M CoI _4 Tompie C1Z=— CO IMP NO
ADDRESS OM N CLOVERLY AVE. JOB.Np
CITY UMPLtgQL%CALIF.
(,( TRUNK PERMIT N0.
REGISTRATION MO If/p/7 / COUNTY
ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT Q`S — S - I Z� I� INDUSTRIAL
,/ WASTE APPROVAL
SIZE OF LOTS,Z /t S NOW ON LOOTa CHARGE&
USE OF
BUILDINGS L CONNECTI AROE FEE
NO DESCRIPTION O WONK REIMBURBFMENTFE
vz0005 SSEWER OO NEAT B O
PUBLICSEWER O i 868 5Z RECEIPT MO ATE IBY
HOUSE SEWER CONNECT NB TO
PRIVATE DISPOSAL SYSTEM 100
NM ET ADDI ION L BLDG OR EXCEPTION RECORD
WORK TO HOUSE 8EWER 100
ALTER ON REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
AMD ort
DISCONNECT
SYSTEM SEWER 1 00 CONNECTION DATA
8 DTIC TANK,SEEPAGE PIT OB
PI
OF NFIELD 2-00 STATION 3-, X DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 000MAUP EFEREXCE
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TYPE ECTION LENGTH FROM /
OWNERS PERMIT $ I 1 Do CUR M L TO P L
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AUTHORIZATION I TOTAL FEE O
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS AY OF ) NEW NOUS[SEWER - $Jl'
OWNER OR BUILDINGCONNECT OR WORKAL
OWNERS ANENT_ _
17
SEPTIC TANK,SEEP.PR(S)
ADDRESS _ AMD ORDRAINFIELD
1 HEREBY ACKMOWLEOGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS, SEWAGE DISPOIIAL SYSTEM
1 HEREBY CERTIFY THAT 1,AM PROPERLY REGISTERED
AND LICENSED AS REQUIRED BY LOS ANGELES COUNT' DISCONNECT PLUG AND -
AMD STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ABANDON HOUSE SEWER 1� / N
SIGNATURE
ABOVE D MMFILL SEPTIC TANKS
R Rom. BEEP PIT(8)O CESSPOOL$
OF PERMITTEE �] /."
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