HomeMy Public PortalAbout5106 SERENO DR_Sewer__ a aK 60211 BB APPLICATION FOR PERMIT 1
DIV=ON OF BUIMI IG AND SAFETY SEWER-SEWAGE DISPOSAL
DIIIPDSIment of County Englnae
County of Loa Angela BUILDING007
LV
JOHN A LAMBIE COUNTY ENGINEER ADDpE33
0 C:ASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
EARFOR APPLICANT TO FILL IN COS ST
LEGAL )�
DESCRIPTION LOT NO /VLA J' loT// OWHER
MAIL
BLOC[ TRACT (� AODR[SS
NO OF BLDGq4L-En3--VATE
CITY
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP YAP
B UILOINGSjWe
CONTRACTOR c �
Z BK 1
ADDRESS O 4 c CONNECTION DATA
0
CITY TEL NO STATION � DEPTH
MANHOLE REFERENCE O TI O 40
/ /C LOWER
REGISTRATION NO L
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF XfiCT10N LENGTH FROM ?^�
PUBLIC SEWER O S S 50 ► Y CU P L Y L TO P L OC
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAIXFIELD ® $S 00
OVERFLOW SEEPAGE PIT GRAINFIELD7 P C NO
E%TN CESSPOOL,DRYWELL,YANHOLE ® $1 00 CO IMP NO V IDB NO
HOUSE SEWER CONNECTING TO y �j
PRIVATE DISPOSAL SYSTEM $100 TRUNK PERMIT NO ROAD PERMIT NO 00I
+Y CONNECT ADDITIONAL BLDG OR STATE ENCROACXYENT
�1
WORK TO HOUSE SEWER S f 00 .Z 4 PERMIT NO
ALTER REPAIRORABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $100 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
OwNms PERMIT f 1 00
AUTHORIZATION SO7AL FEE REIMBURSEMENT FEE
I
HAVE AT CO OATS A CONTRACT ESC THE HEREIN GNAMEDDWELLING LI N-
APPROVALS DATE INSP TOR$SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THI `ADV OF 19__ CONNECT ADDITIONAL
OWNER OR _7) R, / BUILDING OR WORK
OWNERS AGEN 1118 YYY��i1114/--s— w SEPTICTAXK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELO
I HEREBY ACKNOWLEDGE THAT 1 HAVE ALAD 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 AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PER Y ITTEE
JOHN A LAMBIE. Co NTY ENGINEER ATION ROBERT A WOOD CHIEF PLBG INSPECTOR
�K } 5 9 8�5 MAY 14 4 6.5 0