HomeMy Public PortalAbout5031 SERENO DR_Sewer__ APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWE"EWAGE DISPOSAL
DEPARTMENT OF COUNTY ENCJNEM
BUILDING AND SAFETY DIVMOH BUIADOLDING
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CONTRACTOR
ADDRESS S /Q I COHt�C'HOH DASA
CITY \ L.NO - LQ ✓ !L STATION DEPTH
REGISTRATION NO COUNT' MANHOLE REFERENCE UPPER
LOWER
N DESCRIPTION OF R FEE
HOUSE
SEWER
CONNECTING TO ! I
PUBLIC SEWER
SEPTIC TJNR SEEPAGE PIT OR I TYPE OF CONNECTION LENGTH FROM
PITS ANO OR DRAINFIELD a SS 00 Y CURB P L MLT L
OVERFLOW SEEPAGEPIT GRAINFIELD
EXTM CESSPOOL DRTWELL MANHOLE 0 S2 DO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM a SI 00 CO I 0 J
COMMCT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 1 DO NK PERMIT NO • ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ St00 STATE ENT
PERYI
INDUSTRI
WASTE AP 0 AL
CHARGES
OWN `WS PE MIT OO CONNECTION CHARGE FEE _
AUTHORIZATION -TOTN•FEEREIMBURSEMENT FEE
I HAVE AT THCON
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DATE A CONTRACT WITH THE HEREINAMED DWELLING, APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR - - - CONNECTADDITIONAL-
OWNERSAGENT BUILDINGORWORK /
ADDRESS ASE
N TIC TANK SRELD PIT_(S)DRAi - — _- -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION --
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL 0 ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SENEROR ^
I HEREBY CERTIFY THAT 1 AN PROPlRLT REGISTERED
-AND/OR SEWAGE DISPOSAL SYSTEM - - - - --
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE "DYE ABANDON HOUSE SEWER
DESCRIBED-RESIDENTIAL PROPERTY BACRFI LLSEPTIC TANKS 11SIGNATURE SEEP PITS CESSPOOLS _
OF PER
YI
ROBERT A WOOD
Y O N DUPHRVISI_NGME�ICAL ENGI NEKENOINEER
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