HomeMy Public PortalAbout5036 SERENO DR_Sewer__ a axGas 113G APPLICATION FOR PERMIT 1
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
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CCOIIIT 0! Los An$eles FADDRESSOJOHN A LAMBIE,COUNTY ENGINEER //��CASSATT D GRIFFIN SUP T OP BUILDING CZFOR APPLICANT TO FILL INLEGAL iCL �+ REIT
DESCRIPTION LOT NOSI O OF j.0+ 1 .JBLOCK /7 ,/A . C - I Z - I 3 45
ES!
SIZE OF LOT / O^ 7 O XOW ON LOT0 OF S CITY TEL NO
USE OF
BUILDING! D&J DISTRICT NO GROUP YAP
.P. BK PG
CONTRACTOR
y / CONNECTION DATA
ADDRESS /!
CITY L NO �"" STATION ' - DEPTH S �'
MANHOLE REFERENCE /A �� G`_ /W•r}. UPPER
❑ STATE
REGISTRATION NO If Y7 c .30� ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CTION LENGTH FROM
PUBLICSEWER f 3 SO O Y UR! P L Y L TO P L
SEPTIC TANK SEEPAGE PIT OR JdU� QG
PITS AND/OR DRAINFIELD @ $3 DO
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EKTN CESSPOOL DRYWELL,YANHOLE S2 00 CO IMP NO JOB NO
HOUSE
PRIVATE DIISPOSAL SYSTEMER G TO ® !1 00 TRUNK PERMIT NO ROAD PERMIT NO 33�l7S`
CONN ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $1 00 PERMIT NO _
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PEUM s 11 00
AUTHORIZATION TOTAL FEE REINBUR9EM EXT FEE
D
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXI TING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS F �' 19— CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK -
OWNERS AGENT SEPTIC TANK,SEEP,PIT(9)
AODRE33 ANO/OR DRAINFIELO
1 HEREBY ACKNOWLEDGE THAT I 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 AM EWERS SEWAGE DISPOSAL SYSTEM
I HEREBY TIFY THAT I A ROPERLY E ISTERED AND/OR
LICENSED REOUI 0 BY LOS ANGELES C AND STATE O DISCONNECT PLUG AND
CALIFORNIA R TN 1 AY T LEGAL 0 OF THE BO ABANDON HOUSE SEWER
DESCRIBED R IOE AL PROPER BACKF LL SEPTIC TANKS O -
SIGNATURE ��✓ 3 IT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE tOUNTY ENGINEER v ATIOO ROBERT A WOOD CHIEF PLBG INSPECTOR
CC A 0 GR
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