HomeMy Public PortalAbout5012 SERENO DR_Sewer__ eB APPLICATION POR PERMIT
IVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1
Depla�wt of Counts Engfno
Counts of Los Anadw BUILDING 5012 Sereno Drive
.JOHN A L.AMBIE COUNTY ENGINEER ADDRESS -
CASSATTD GRIFFIN SUP T 01 BUILDING LOCALITY Temple City, California
NEAREST
FOR APPLICANT i0 FILL IN CROSS 5T Encinita
L STAMM
OWNER Mulkey DESCRIPTION LOT NO `
BLOCK TRACT MAIL 5008 Sereno Drive r-
LcAA CAS ADDRESS
�,v G- e��
SIZE OF LOT (N X 2W NOW ONBLOTS CITYTeID a City- TEL NOUSOryy {�16W -
BUILDINGS dewllings DISTRICT NO GROUP YAP `
SK • PG _
CONTRACTORL. zz: 0
ADDRESS S CONNECTION DATA
CITYJ., TEL NO O
U &,p STATION DEPTH
MANHOLE REFERENCE/ PPE
❑ STATE
REGISTRATION NO 3 Ir ff ❑ COUNTY
NO DESCRIPTION OF W RK F E TYPE OF COYNiCIION LENGTH FROM
HOUSE SEWER CONNECTING TO 7 /CURB 1 P L Y L TO P L
PUBLIC SEWER @ S
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELO ® s S 00
OVERFLOW SEEPAGE PIT GRAINFIELD CO IVP NO JOB NO
EKTN CESSPOOL ORYWELL MANHOLE ® S 2 DO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 6 S 1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER a S 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM a $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE _
OWNERS PERBUT S 00
REIMBURSEMENT FEE `
AUTHORMTION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING F
TO THE PUBLIC EWER XEW HOUSE SEWER
SIGNED THI AY OF 19 59 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS Tem a Cit li AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W17H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY ' BACKFILL 9YlIYt� ,.
DRQ SYYIMiY11MPB CESSPOOLSefr-/V-r71
-
RYITTEE LAMME.COUNTY ENGINEERO , P 9PECTDR _
VALIDAIIOIy ROBERT A W
CK Y 0 Qt J
X05.9 4 8my 7 1 O-A 6.0�p0�• 9 -