HomeMy Public PortalAbout5059 SERENO DR_Sewer__ �,. DEPAIETD>'ENT OF COUNTY ENGII4EM I SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
FpRTO FILL IN LOCALITY I
BUILDING ///�����{y�p�p �1+/`�'Ty ////[�/, NEARES �I
ADO RE86 (/ `)�R �yQ ' ^� I CROSS BT e"$�
LOCALITY 1 DISTRICT NO SERIAL NO OPEERMIT NO c
NEAREST A 1Q 1 O3 `T
CROSS ST
RECEIVED BY Reedy for l0apeetlo0 DA^E IBSU D
OWNER _ 2 5 S
MAIL USE ZON OCCUPANCY MAP
ADDRESS
BK PO
CITU /O L NO I A-1 I
CONTRACTOR 4pv�_/�OT CO IMP NO
ADDRESS /e r-+'Sn E�Uf' L�L� IpL7L/ JOBNO
CITY Lsjs/�/�7R1��e� $`L NO /�J L`��I TRUNK PERMIT NO "
REGISTRATION NO ,7 Q•3N B STATE z
COUNTY ROAD PERMIT NO
LEGAL /0-0�50
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
812E OF LOT +' NO OF BLDG'
NOW ON LOTUSEF
I 1 /HAgBE'
BUILDING' IUFj„L,) /IJ A CONNECTIO RGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE--',_
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ! 2 000 RECEIPT NO BY
HOUSESEWER GONN INS TO '
PRIVATE DISPOSAL SYSTEM 100 i
�- WORK C XOUBE ONALSEWELOB OR 100 I EXCEPTION RECORDED
. ALTER RR PAI EXISTIN NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER CONNECTION DATA
AND/OR DISPOSAL SYSTEM ANDD 100
SEPTIC TANK,SIELPAGIE PIT OR
PITS AND OR GRAINFIELD 200 PISITATION q ,Q� DEPTH Cp
E L-DRYWELL HQLEHF
SPECIAL CONDITIONS ONLY 200 I , IMANFERENCEYPE O AIF CQN!(ECTIONN LENGTH FROM
OWNERS PERMIT $ I �_!'� M L TO P L ?�S
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
TH�
SIGNED THIS �L DAY OF IVJ3 NEW HOUSE SEWER r - a
OWNER OR //////��'�'� '� T L�' - ' CONNECT ADDITIONAL
OWNERS AGENT Y.({lf��� BUILDINGORWORK
ADDRESS _ - AEPTICTANK BEEP IT(8)
ND/OR ORAINF ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[] ORYWELLD
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCE'AND STATE LAWS ALTER REPAIR y SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOYAL SYSTEM
AMD/OR LICE BED IAB REQUIRETHAT I D BY PROPERLY
ANGELES COUNTY
DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM TH LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE�E�Cq►�ED DE _ 1 PERTY KFILL SEPTICTANN
SIGNATURE L//17r^,r^f EP PIT(B)[] CE88Pociam
OFPERMITTEE _
78AU2A 663 7/53