HomeMy Public PortalAbout5034 SERENO DR_Sewer__ 24650 1NSM'
Guoee eo APPLICATION FOR PERM IT'S
TeeeA:o CODNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL , 1
DEPARTMMT OF COMM ENGMM
Mmro NG AND SAFEST DIVISION 'BUILDING 0 0
�? �Q�!� ADDRESS v
OffiP A IP.NBEN, aaV 1 e R�'1G LOCALITY 1
NEAREST
LEGAL
FOR LICANT TO FILL IN CROSS BY
1
DESCRIPTION Lofo dAr I Ce OWNER'
MAI
BLOCK TRACT S LO ` •� ADDRESS
NO OFBLDG9
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS im Q,,I� DISTRICT NO GROUP YAP PG PR BY
CONTRACTORIc/ O 11-k7 U
ADDRESS .� �—�' CONNECTI N DATA
CIT TEL NO LOO ON 08RH
s' STATE 'MANHOLE REFERENCE r
REGISTRATION NO COUNTY WElt
No I DESCRIPTION OF WORK FEE
PUBLIC SEA ERCONNECTING TO S 00
TYPE OF CONNECTION LENGTH FROM
SEPTIC TAN'( SEEPAGE PIT OR Y CURB P M L TO P L J
PITS AND OR DRAINFIELD @ S9 QQ
OVERFLOW SEEPAGE PIT DRAINFIELO
EZ H CESSPOOL
ESSP DRYWEL 2 DO
HOUSE SEW ER CONNECTING TO P C NO
PRIVATE DAI Ppp09A STLL M 1 00 CO IMP NO JOB NO
CONNECT
ONK TO EIOIISEISEWER LDG OR s 00 TRUNK PERMIT NO ROAD PERMIT RO O
A T R EPAIR OR ABANDON HOUSE STATE EXCROACXYENT tl
$I 00 PERMIT
INDUSTRIAIA
L
HASTE APPROVAL
CHARGES
OWNERS PERMIT 7S 00 CONNECTION CHARGE FEE
AUMOECLATION I TOTAL FEE REIMBURSEMENT FEE
TAAVE AT CTOR TO CNAMEDS DATE A CONTRACT WITH THE HEREIN
ONNECT THE ABOVE DESCRIBED EXIISTING
RDWELLING PJ)MOVAM DATE INSPECT SSIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS AlnOFT1B_ NEW ROUSE SEVER
OWNER AGENT � // CONNECT ADDITIONAL
OWNERS A ��iL BUILDING OR WORK
ADDRFaa LABANDON
TANK SEEP PIT(S)
DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYOL DRYWRLIWITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATINGPLUMBING AND SEWERS REPAIR SEWER OR
SEW1 HEREBY CERTIFY THAT 1 A■ PROPERLY REGISTERED AND/OR DISPOSAL STSTEY
LICENSED AS REOUIRED BY LOS ANGELES COURTS AND STATE OF_ NECT PLUG AND
CALIFORNIA OR THA 1 AY THE LEGAL OWN OF THE ABOVEX ROUSE SEWER
SIGNATURE RESIO T L PROPERTY LLGE IC TANKS 1:1
CESSPSIGNATURE / IT a CESSPOOLS
OF PERMITTE
mT VAI.IDATIOI— RO ERT A WOOD
CAFB /
Cr. ■ 0 i8UP'ERYIBIN6 MECHANIC/1L MNOINBBTi
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APPLICATION FOR PE MIT
woe a B! COUN" OF LOS ANGEM
DFBABTMEM of COUNTY ENCiINBEH SEWER—SEWAGE DI L
BUILDING AND SAFM DrVMON BUILDING
Tp� ��eY ADDRESS
Cd8811Tr A 6H�P�C. 8Yy'/ of 1(= LOCALITY C�
NEAREST
FO C CROS!
LEGAL
DESCRIPTION L N / OVIXQA
BLOCK TRACT Affs. ,�f, 2 -+/,3 ooRESb
NO OF BLDG!
SIZE OF LOT NOW ON LOT CIT TEL NO
DISTRICT NO GROUP YAP PROCESSED BY
BUILDINGS EOF
I O KK PG
CONTRACTOR .�n 0
ADDRESS 7- CONNECIION DASA
CIT TEL NOfilGN 3DEPTH
SPATE MANHOLE REFERENCE Dl
REGISTRATION NO xo, COUNT Q ♦ OWER
NO 1111 DESCRIPTIO WORK FEE
YOU&SEEl1ERCONNECTING TO S300
SEPTICTANK SEEPAGE PITOR 7 TYPE OF CONNCURB ECTIONP Y6NGTTOH FROM
PL
PITS AND/OR DRAI N FIELD
OVERFLOW SEEPAGE PIT DRAI NFIELD
HOUSE EWER CONNECTING TO )377 Pc
NO
RIVE AIS AL�S�YLSTEY CO IMP NO JOB NO
WORK TO NOI I'So WER LOG OR TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAR OR ABANDON HOUSE I STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PEn= CONNECTION CHARGE FEE
AUTHOMATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTCT WITH THE IINGAMED DWEWNG AMOVAM DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT__%=f:7f� BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
AMD OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPU CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCE! AND STATE LAWS REGULATING
PLUMBING AND SEWER! ALTER REPAIR SEWER
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICKNSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE 1 PROPERTY BACKFILl9E C TANK!
SIGNATURE
LEP PIT ! CESSPOOL!
OF PERMIT
m♦ VAIMAJhO RO E T A WOOD
B.0. CUB SA)PEAVISING MECHANICAL ENGINEER
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