HomeMy Public PortalAbout5062 SERENO DR_Sewer__ I
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CEBN'"F' ° B' APPLICATIOMFOR PERMIT ; .
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
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FOR APPLICANT TO FILL IN DISTRICT NO GmuP - rAF Plt u5 ED By,
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CONNECTION DATA
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{NSE NODESCRIPTION OF WORK PE{ APPROVALS DATE INSPECTORSSIGNATUR
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PUBL SEWER
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OVERFLOWS{{PAGE PR DRAINFIELD CESSPOOL ❑ DRYWBLL❑
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ALTER REPAIRORABANDONHOU86 ALTER REPAIR SEWEROR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
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ABANDONXOUSESEW[R
HACKPILLSEPTICT1N"D - -
Permit S SEEP PITI81❑ CESSPOOLS❑
OWNER'S -
AUTHORIZATION TOTAL FEE �' VALIDATION
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I HAVE AT THIS own A CONTRACT WTTH THE HEREIN N eD CON _ ._ _ __
TRACTOR TO CONNECT THE ABOVE DESCRIBED"jflTHO DWSLLINo
TOTHC PUBLIC SHIVER
SIGNEOTMIS7 YOF19 _ _ i179,4AOWW -
ENB AOe `— _ _ HHB Q
ADDRESS 6
- I Hamby ACKNOWLEDGE THAT 1 HAV[ READ THIS APPLICATION - -' - •• LOO -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RHODUITNO Est -J 4,00E_
PLUMsU ANDS{W{RS -�. - --- T -
I Hammy C{RTFY THAT I AY PROPERLY REGIST MD AND/OR '
LICBNBED AS REQUIRED BY LOB ANGELES COUNTY MID STATE OR
CAUFORNIAOR THATIAM THE LEGAL OWNER OF AND UVTEND TO RH 12 3— 8
SION IN THE ABOVE DIISCRIBlD RtIIDENTIK PROPERTY
sM.ATURA - - —-'
OR PERMTRE{