HomeMy Public PortalAbout5110 SERENO DR_Sewer__'°""Y APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMMON ADDRESS N
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SCRIPTION LOT NO AL A 7 7 O/ / OWNER
BLOCK TRACT �L — ADDRESS /�
NO OFBLDGS
SIZE OF
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USF OF
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CONTMCTOR e N �Y•(�(C\I.
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CITY L /y TEL o 2 DEPTH
ATE ROLE REFERENCE /
REGISTRATION NO COUNTY
NO
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N OF WORK FEE
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SEPTIC TN SEEPAGE PIT OR T CURB P L Y L TO P L
PITS ANO�OR DRAINFI8L0 f DD
OVERFL ,A SEEPAGE PIT DINFIELD
EXTX E OL DRTNE RA0
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P A POA 100 CO ITP NO JOB MO
NOIR C XOUSEISEWLBLDG OR TRUNK PERMIT NO ROAD PERMIT NO d
AWT R EPAIR OR ABANDON HOUSE STATE ENCROACHMENT
QIRPOqAI Sim PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 21 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREITRACTOR TO CIOXNECT THE ABOVE DESCRIBED EXISTING"MED PPR
DWELLING AOVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS ^AY OF 18_ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS
SEPTIC TANK
DRAINFEELDEP PIT(S)
I HEREBY ACKNOWLv6QE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER E
I HEREBY CERTIFY THAT AY PROPERL REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED A7 REQUIRED LOS ANGELESCO MTT AND STATE OF DISCONNECTBANDHOUSE SAND
CALIFORNIA OR THAT 1 TXE LEGA C THE ABOVE ABANDON HOUSE SEWE0.
DESCRIBED RESIDE P OPERTY BACKFILLSEPTIC TANKS
SIGNATURE SE PIT ESSPOOLS El
OF PERI
LP - VALIDATION ROMEAT A WOOD
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"a APPLICATION FOR PERMIT
aaw a as COUNTY OF LOS ANGELES
' DEPARTMENT OF COUNTY ENGDveea SEWER—SEWAGE DISPOSAL
SUdDIN6 AND SAFETY DMSION BUILDING
ADDRESS CA 9
OHR A. LID® CemtT
D 6YIpFIIT. Buy t d DWidLm LOCALITY t
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DESCRIPTION LOT NO A Ce OWNER
BLOCK TRACT 5 ��— CARESS �/� SIV �� 1eb-,/� QI
SIZE OF LOT NONON OOF XTOS
USE OF
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ILDINGS G DISTRICT NO GROUP YAP PQ PROCESSED BY
CONTRACTOR 71
ADDRESS l.•J f pCONNECTION DATA
CITY 4- M\ P TEL NO C,Q S STATION DEPTH I O
REGISTRATION NO STATEMANHOLE REFERENCCOUNTY I!R 11fi
No I D RIPTION WORK FEE `'
HPUOBSECSg RRCONXECTIN6 TO SS 00 TYPE OF CONNECTION
/ LENGTH FROM/�"
SEPTIC TANK SEEPAGE PIT OR T CURB P L ■L TO P L
PITS AND/OR DRAINFI FL
D@ 33 00
OVERFLOW SEEPAGE PIT DRAINFIELD
CESSPOOLEXTN TWELL Z 00
HOUSE EWER CONNECTING TO , P C 0
RI T DISPOTTSA by EY 100 CO IMP NO JOB NO
WORK TO XUU9EISEWER L06 OR 0 TRUNK PERMIT NO ROAD PERMIT NO Q3
ALTER EPAIR OR ABANDON HOUSE STATE ENCROACHMENT
1 PERMIT NO
INDUSTRIAL A Y A
WASTE APPROVAL
'Q
CHARGE
OwIIIm I PEHNST CONNECTION CHARGE FEE �/ J
AUMOEMTION TOTAL FEE D J REIMBURSEMENT FEE V�
TRACTOR TO CIONNECT THE ABOVET DESCRIBED EXISTINGWTTH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS NAY OF, 79_ NEW xou4E SEWER
OWNER OR -��il����� CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PITO)
AND/OR DRAINFIELD
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION <
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYNELL 13
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEVER OR
PLUMBING AND SEWERS ALTERSEWAGREPAIR DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT AY PROPERL EGISTERED APD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B LOe ANGELES 0 NTT AND STATE OF
CALIFORNIA OR THAT 1 THE LEGA 0 ER OP THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEN IA OPERTY BACKFILL SEPT C TANKS ❑
SIGNATURE SEEP PIT(S) CE49Po
OF PERYI D
L. /IYAI,IDATIONWO
OMEZ A OD
1110 CAMSUPENVIBING MYGiANIVO YNOIN6liTi
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