HomeMy Public PortalAbout5110 1/2 SERENO DR_Sewer__ CUD& a APPLICATION FOR PERMIT
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ADDRESS
OHR A. WIN Cewt�
LT D ORWFM. SRP t d DuDd�eQ LOCALITY P
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DESCRIPTION LR NO To r OWNER 'Al • d l oft&I iv
BLOCK TRACT 5 13 AD KESS 5�1/v N
NO OF BLDGS
SIZE OF LOT NOW ON LOTCITY TEL NO
USE OF
BUILDINGS P DISTRICT NO GROUP � O YAP PROCESSED BY
CONTMCTOR N b+ l
ADDRESS L CONNECTION DATA
CITY •tifepTEL NO 1 PTX Id
ATE16111101E REFERENCE DPP
REGISTRATION NO 7 COUNTY R
NO I D��ESCR PTION O WOR FEE S
HOULE SEWERSRCONNECTING TOPUB ® 9 00
PE OF CONNECTION LENGTH FROM L�
SEPTIC TANK SEEPAGE PIT OR T CURB P L Y L TO P L J
PITS AND/OR GRAINFIELD 9 00
OVEZXTRFLOW SE35EEPAGE PIT DRAINFIELD Z
90
ROUSE SEWER CONNECTING TO P C NO -
RIY T DISPOSALSYST I 1 CO IVP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEVER a sl 00
ATR REPAI R OR ABANDON ROUSE 100 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT T 00 CONNECTION CHARGE FEE
ADTHO=ATION I TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE cm-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EZISTIINGAMED DWELLING APPROVALS DATE INSPECTOR 8 SIGNATUJUS
TO THE PUBLIC SEWER
SIGNED THIS DAY 0 is— NEW HOUSE SEWER LO
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRE SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPU CESSPOOL 0 DRTSPELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SENE0.0R '
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY 'IS
ANGELES COVAIV AND STATE OF ABANDON ROUSE SEWER
CALIFORNIA OR THAT 1 THE LEGAL 0 OF THE ABOVE
DESCRIBED RESIDEXTIA PERTT BACKFILL SE C TAN" Ll
SIGNATURE S PITS CESS LS
OF PERYITTE
LP K AMATION ROBERT A WOOD
`" b= -7 �Y/� f �• Y O ,,B SUPERVISING MMCHANICAI GNGINEM
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APPLICATION FOR PERMIT
Lvov e
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
.. —kEPABTMEN[ OF COUNTY ENGITMER
BUMDING AND SAFETY DIVISION ADORE9BDILDIN9G
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1089 A. IAUOIE q�t a1 .B
TE D GEWM?BNIW LOCALITY T
NEAREST
FOR APPLICANT TO FILL 1N cao33 sT
LEGAL
/
DESLOYND OWNER _M O /'• .tel
BLOCK TRACTMAIL
�-- ADDRESS 'J Q
i
SIZE OF LOT
NO OFBLDGS
3 NOW ON LOT CI No
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
CONTRACTOR /f BK PG
h p
ADDRESS 2- d / CONNECTION DATA
CITY L M S TEL NO 2 YQJ STATION16
�- 3 DEPTH
ATEREGISTRATION NO COUNTY XO REFERE E '
P
NG I DSESCRIPTIO OF R FEE
PUBLIC SEEWEERCONNERING TO 0 S3 00 Z
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LrENGTH FROM
PITS AND/OR DRAINFIELD T CURB P L Y L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CSP L @ sz:
HOUSE SEWER CONNECTING TO P C MO
P IVAT A SY EM 100 CO ,,P NO 377 JOB NO
CONNECT ADDITIONAER f L BLDG OR TRUNK PERMIT NO ROAD PERMIT NO 0
WORK TO NOOSE SENDo
A TER REIN ISPOOR D ABANDON HOUSE SI 00 STATE ENCROACHMENT
SYSTPERMIT NO
INDUSTRIAL
WASTE APPROVAL 1
0 J CHARGES
OVMEkS I PERM T CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE A REIMBURSEMENT FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SINNED THIR Y OF tB_ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
AGE
OWNERS AGENT BUILDING 00.WORK
ADDRE AND IC TD.K SEELDDEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWEROR
I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED B LOS ANGEL UNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 THE LE 0 HER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RFEIDERTIA OP�TT BACKFILL SE C TANKS
SIGNATURE SEEP PIT B CESSPOOLS ri
OF PERM
®1mmmoALMATION ROBERT A WOOD
Q Y 0 cux SUPERVISING MECHANICAL MNGINKM
LAC011935; MAY23 1 1 A 2 5.0 0 M.
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