HomeMy Public PortalAbout5029 SERENO DR_Sewer__ 200 -7
DEPARTMENT OF ()OUT= ENOINIMR SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OODNTY OF L08 ANGELES
WILLIAM J FOX. COUNTY ENGINEER BUILDING O ^ O ( k2_ O I/I
1 BUILDIADDRENG
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FO APPLICANT TO RLL IN LOCALITY -L G11 1
ADDRESS Z Q /►p -] Y4 y�Q I� CROBB SST GL
LOCALITY M to I (2 "r� DISTRICT NO SERIAL NO PERMIT NO
NEAREST 5 A ` - S
CROSS ST R CEIVED BY Boaft for lupwu*n DATE ISSUED
OWNERI 'i-'
G _ 1 -
MAILUSE ZONE OCCUPANCY BK MAP
ADDRESS PG
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CITY f 4m,h t-ice( ltu TaM /PSS Z2
CONTRACTOR' -.,r S, CO-IMP NO -7 —
ADDRESS 4`�C' 2:!F- A60 1£V�� JOB.N0.
CITY 7g4 jr TELNO �STA� TRUNK PERMIT NO
REGISTRATION NCI 8 COUNTY ROAD PERMIT NO 'Z rj 5 (8
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT NO29 over, PERMIT NO
BLOCK TRACT SGC INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT G• O X,;( NOOF W ON LOTIIa CHAflO
BUILDIUSEOFNGS
CONNECTION CNARGE E
BUILOIM88 U I
NO DESCRIPTION OF ORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER a 850 D RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT AbbrrlONALBLbO OR EXCEPTION CORDED
WORK TO HOUSE SEWER - 100
ALTER OR REPAIR MISTING MO DA BY
SEWER OR DISPOSAL SYSTEM Ido
DISAND/OB DISPOSAL SYSTEMCT AND M EWER 1 ro CONNECTION D TA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND OR DRAIN FI E L D Zd0 STATION p Z DEPTH
SSPOOL-ORYW ELL
SPECIAL CONDITIONS ONLY 200 / ANXy OELEERREFERENCE OWE
TYPE OF CTION41;0 YEN TOHPFL OM .S A
OWNERS PERMIT S I 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8SIGNATURE DATE
DWELLING TO THE PUBLIC SEW
SIGNED THIS Y OF 1 NEW HOUSE SEWER -
OWNER OR CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
SEPTIC TANKK,,SEEP PIT(8)
ADDRESS ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLU MBIN AND SEWER& SEWAGE DIBPO"L SYSTEM
1 HERESY CERTIFY THAT 1 AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AMD STATE OF CALIFORNIA O THAT I AM THE LEG OWN- ABANDON HOUSE SEWER
ER Of THE AROVE_ DEW BF RESHMINTIAL PROP BACKPILLSEPTIC TANK
BEEP PIT(S)0 CEBbPo0l8
SIGNATURE t/
OF PERMITTEE
IGA642A 009 7/53