HomeMy Public PortalAbout4936 SERENO DR_Sewer__ DEPARTmzNT OF COUNTY ENOIIYEER SEWER-SEWAGE DISPOSAL 1
DMSION OF EIMMI dG AND SAFETY
COUNTY OF LOS ANOPERMIT APPLICATION
ELFB
WILLIAM J. FOX. COUNTY ENGINEER BUAODILDING
RE88
FORAPPPUCAbT TO RLL IN LOCALITY
ADDSSFO/✓ NEAREST
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LOCALITY C DISTRICT NO SERIAL NO PERMIT NO
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EAREST 1 f L,/ A � -S7 7J
CROSS 8T
R EI EO BY Rum tar IaoPNtloO DATE ISSUED
OWNER ,/ w
ADDRESS y� 7r h2 118E ZO NE OCCUPANCY
CITY 6 BP"PS
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CONTRACTOR ,,g���LL�(I lU
CO IMP NO
ADDRESS J-:K
JOB NO
CITY IJ fMXQ6 TELMO Z;Z 7 TRUNK PERMIT NO �
STATE
REGISTRATION TION NO `` COUNTY ROAD PERMIT NO
DESCRIPTION LOT NO ]�� �^ 7e r STATE ENCROACHMENT��>
NO
BLOCK TRACT I INDUSTRIAL
SIZE OF LOT SAS�OQ MO OF BLWASTE APPROVAL
OT
((�� NOW OM LOT / CHANCES
USE OF T�1 w�(+L//(��. CONNECTION CNAR PEE
BUILDINGS Ll
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FE[
HOUB[SEIYER 00 NEDTIMB TO q
PUBLICS EWER ® i SSS J RECEIPT NO ATE BY
PRIHbUVATE TE DISPOSAL SYSTEM-FIEWER CONNECTING O 100 _
CONNECT ADDITIONAL AL BLDG IXC ON R CORDED
WORK TO HOUSE SEWER 100
A OR REPAIRE ISTI N DAT BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT DI OS ABANDONSEWER CONNECTION DATA
AND OR TANK.SEEPAGTEM 100
9915110 PITS AND/OR GRAINFIIELGE D GY 200 STATIONI ��� DEPTH
SP DIAL CONDITIOMBONLY 200 MANHOLE t �
TYPE OFCIOIMBNECTIONB. MEL TO P LOM .3
OWNERS PERMIT $ 1 00
AUTHORIZATION rorAL FEE I"
1 HAVE THIS DAT[ CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPE ORBBIGNATURE DATE
DWELLING TO THE PUBLIC SEWE
SIGNED THIS 112- DAY OF IRb� NEW HOUSE SEWER N (,Ss
OWNER OR �Q ���,�� CONNECT ADDITIONAL
OWNERADDRES AGENT. acv =.�_`_a --� SEPTIC TAMBUILDING RWORK
K,BEEP.PITS)
ADDRESS _ 6 �h'A�,�
AND/OR ORAINFIELD
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 ALT[II.flEPAIR.BHWER OR
REGULATING PLUMBING AND SEWERS 6HWA EOIBPo LSYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
ER OF L16ENBEOAJ Y L06 ANGELES COUNTY 01860MMECT PLUG AND
AND STATE OF ORNIA OR THAT 1 ASI THE L BAL OWN• ABANDON HODS[SEWER
ER OF THE ESC DEMfI� 8 AMKS
!'/L/ [fiV PIT(d)� O[SSPOOIF �{,
618NAT a"
OF PERMITTEE— _ _
MASIIIA OSS 7/06