HomeMy Public PortalAbout4967-4969 SERENO DR_Sewer__ D
soK 6APPLICATION FOR PERMIT 1
DMMON OF BUMMIG AND SAFETY SEWER-SEWAGE DISPOSAL
Drp�lmant of Camey Eegimar
�O°°M of LD' ADg'ka ADDRESSO e r
WM.J FOX.Coumy ENOINaBTm
CALGATT D ORIPFIN.a"T or 13UILDIILD LOCALITYLEGAL
OR APPLICANT TO NEAREST �� �_!h / / a
CROSS 87.
DESCRIPTIO 0 0 S • SFWWOI OWNER
BLOCK TRACT f"IN3 Al red Ore Sw line C7G MAIL
ADDRESS
NO 6F BLDGS
SIZE LO NOW ON LOT Z CITY TEL NO
USE
BUILDINGS DISTRICT NO GROUP YAP
CONTRACTOR ^ BR PO
IVO i
ADDRESS 2� CONNEC17ON DATA
CITY S S TEL NO STATION
• DEPTH
❑ STATE MANHOLE REFERENCE IL UPP
REGISTRATION NO Z ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �l_ TYPE VECTION LENGTH FROM
PUBLIC SEWER ® S S 30 7p T UR P L M L TOP L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECT ADDITIONAL BLDG OR P C NO
WORN TO HOUSE SEWER 1 00 CO IMF NO JOB MO
ALTER OR REPAIR EXISTING /O
SEWER OR DISPOSAL SYSTEM 1 DO TRUNK PERMIT NO ROAD PERMIT NO v
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
FITS AND/OR DRAIMFIELD 00 INDUSTRIAL
CESSPOOL•DRTWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY t 00 CHARGES
CONNECTION CHARGE FEE
O{pNEg$ MUMS 1 00
AUTH0BMTI0N TOTAL FEE S REIMBURSEMENT FEE
I HAVE TRACTORTO DATE CONNECT THEACTED WITH THE ABOVE DESCR BEDH D(IBTINQAMED DWELLIO G APPROVALS DATE INSPECTOR 6SIGNATURE
TO THE PUBLIC SEWER
SIGNED THI DAY 0
b— 1LF NEW HOUSE SEWER
1
HER
OR CONNECT ADDITIONAL
OWNERS AGExT� —BUILDING OR WORK
•• SEPTIC TANK BEEP FIT(EI
AODRESa AND/OR DRAINFIELO
1 HEREBY ACKNOWLEDGE THAT P HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE REPAIR
DISPOSALEWEROM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIB D RfiSIDfiNTIAL�ROPERTY , `
.L//�_'N- Y/ IACKFILL SEPTIC TANKI�
9EEP PIT B CE, r
WILLIAM J.FOX.CDONTY ENommER VALMATION R A.WOOD.CHIMP PLso INevacrOR
rs--�
JC7 4 5 EN JUM27 4 5.50 11