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HomeMy Public PortalAbout5008 SERENO DR_Sewer__ t 10- 43 a APPLICATION FOR PERMI COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENG2fEER BUILDING AND SAFETY DIVL4ION euILGING / WMA LAW= Ca F, [[( AGGnla WQ.LIAM A IENSEN Sup[ DI B ddm9 IOULI NEAREST FOR =W T `"O°° By LEGAL DESCRIPTION LOT NO OWNER 1 Vku MAIL [LOCK / TRACT ADDRESS SIZE OF LOT bO I( 2-SNOW OH LOT' 3tSTA� Y 1 TEL NO USE OI ? aUILDINOS 3— .11J /,- A [,[L{A ICT GROUP MAP PROC DpY /^ SK POj� CONTRACTOR ` • v I S0 (_/ ADDRESS O CONNECTION DATA CITY Q TEL NO TION DEPTH �1 NHOLE REFERENCREGISTRATION NO O ` NO DESCRIPTION OF WORK FC[ TYPE OF CONN ION LENGTH FROJR HOU[6 S6Wd CONNECTING TO Y p P L M L TO P L 6 PUBLIC atW[R O [a 00 a PTIC TANK SEEPAGE PIT OR P C HO O PITS AND/OR GRAINFIELD 0 11000 CO IMP NO /, UG[HG V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD pSfMli x0 / K PRIVATE DISP69AL SYSTEM Sa 00 O CONNECT ADDITIONAI BLDG OR AFFIDAVIT I FYYO (U[E[R RECORD IHSTR NO DATE WORK TO HOUSE SEWER Y 53M OVERFLOW SEEPAGE PIT DRAINFIELD °STN CESSPOOL DRYWELL MANHOLE O $5 GO a ALi°R-#EPIOR'OR'ASANDON HOUSE HWY OR ST WIDENING N SEWER ORSbPOSRL SYSTEM C 23M �b STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTEAPPROVAL CHARGES OWNER'S PERMIT s z o0 AUTHORIZATION TOTAL FEE M CONNECTION CHARGE FIR I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONN CT THE ABOVE DESCRIBED 6EISTINO DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OR IS_ OWNER OR NEW HOUSE SEWER OWNERS ADEN T CONNECT ADDITIONAL r LADDRES5S BUILDING OR WORK / ESY ACKNOWL[DOC THAT IHAV[ RGD TRIS APPLICATION °OPTICTANK S66P PITIS) ATE THAT THC ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DIIAINFICLO LL COUNTY ORDINANCES AND STATE LAWS REGULATINGCESSPOOL ❑ ORYWtLLNO AND SCW IRBEBY CERTIFY THAT I AM PROPERLY R[OIST[R[D AND/OR ALTER REPAIR SEWER OR ED AS REOUI RCD aY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOpAL SYSTEM RNIA OR THAT IAMTHE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND IN THE ABOVE G[ [D REYID[NTIAL PROPERTY r AMNION HOUSE SEWERURE pACKFILL SEPTICTANKS ❑ [RMITT[[ SCEP PITI°) ❑ CESSPOOLS 6ATION ROBERT A WOOD DK M G CASH SUPERVISING MECHANICAL ENGINEER LACO2s o a�2 ,,m1'0 i o o 1 1.00, a