HomeMy Public PortalAbout5021 SERENO DR_Sewer__ Ts
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ato APPLICATION FOR PERMIT �
DNMON OF BUMDING AND SA= SEWER—SEWAGE DISPOSAL
1 DMpmrlmont of Co mtp Englnea
Court!
Of Em Angeles BUILESS OZI O DR A
WM J. PDX. COUNTY ENGINEm ADDRESS �/... v�C
CJISBATT0 GRIFFIN,BU►T or BUR.DIIIe LOCALITY /
FOR APPLICANT TO EU IN NEAREST
CHOSE 9T Aga A 16d
LEGAL DESCRIPTION LOT 10 Z 7 A OWNER ;�gp J.
p ..SQ
BLOCK dZetesAa ADDRESS -VV Z I SFIL �AR
F BLDGSIZE OF LOT 0 NOWOON LOTS ' CITY TEL NO .'�
USE OF
BUILDINGS DISTRICT NO GROUP YAP
CONTRACTOR
ADDaess ffZ� S'�f�,.yGC,O �'L CONNECTION DATA
CITY TEL NO 3 STATION DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION 0 COUNTY ER
NO DESCRIPTION OF WORK FEE
ROUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER ® S !SO Y CURB P L Y L TOP L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR .��//�� P C NO
WORK TO HOUSE SEWER 1 00 ASV CO IMP NO JOB NO
ALTER OR REPAIR EZISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 DO PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 00 INDUSTRIAL
CESSPOOL•DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY Z 00 CHARGES
OWNEWS PMIMTS 1 00 CONNECTION CHARGE FEE
AUTHOBIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE TRACTORTO DATE CONNECT THEACTED ABOVEWITH THE HERINMPO CN.DESCfl BED EZE9 NINGA OW ELLIONG APPHOVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS SAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT($)
ADDRESS AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES TY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR TH Y THE LEGAL WN OF 7X8 ABOVE ABANDON HOUSE SEWER
DESCRIBED REBID IAL P OPERTT
BACKFILLS IC TANKS
SKU PIT B C"POO
SIGNATURE A
OF PERMITTEE
WIL UAM J FO LINTY ENGIN VALIDATION R A.WOOD.CHIME PILING INYPiCTOR
_TO 9044 AUG 8 4 2 0 Q "�
a:Ea 311.55 APPLICATION FOR PERMIT 5
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
COulstp of Los Angeles BUILDING :tee
JOHN A. LAMBIE. COUNTY ENGINEER
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CR SRS ST. N CFI A/, 7 /-I /-
LEGAL
DESCRIPTION LOT NO. 7. / ,-/ ,t 7 OWNER
MAIL /
BLOCK! TRRET; ADDRESS /I _ /I�' ! ✓C
SIZE OF LOT r'+ + (..
NO. OF BLDGS. CITY TEL. N0.
NOW ON LOT ti
USE OF
BUILDINGS I !--!- C I. ! Al f- J DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR u,, jij /y
ADDRESSA ,tp CONNECTION DATA
STATION DEPTH
CITY /f At jF TEL. NO. ,w_APE_IUPPER
MANHOLE REFERENCE
❑ STATE LOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. N.L.TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO, IMP.NO. JOB NO.
I MOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM @ $I-o0 TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
! WORK TO HOUSE SEWER @ $1.00
PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE •O
SEWER OR DISPOSAL SYSTEM @ $1.00 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERM S 1 00
AUTHORIZATION TOTAL FEED J EIRMBURSEMENT FEE
I NAYS AT THIS DATE A CONTRACT WITH THE HEANED CON. APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE pGG,CRIBED EXISIS TING DWELLING
TO THE PUBLIC SEWER.1 �. NEW ROUSE SEWER
SIGNED THIQ?DA}�OIQ J CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG,F[1T / SEPTIC TANK,SEEP,PIT(S)
ADDRESS -� AND/OR DRAINFIELD
I HEREBY ACKN LEDGE THAT iLMVE 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 SEWER5. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) [ICESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALMATIQW ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.9. J Usk,.'