HomeMy Public PortalAbout5112 SERENO DR_Sewer__ caeoe4 as APPLICATION FOR PERMIT
7
COUNTY OF L08 ANGELES SEWER-SEWAGE DISPOSAL
ITHiEIENY OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AODREl9 f
089 A, LALERDL ?
TE D 6!l�Plm, Sept W BWM.0 LOCALITY P rK 60 Ct /
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
DES LEGAL LOT NO T OWNER
Al L
BLOCK TRACT S I z—� ADRESS L- PlyrN O
NO OF BLDGS
SIZE OF LOTS NOW ON LOT CITY TEL N
",OF
BUILDINGS DISTRICT XO GROUP YAP PROCESSED BY
O _ FG
CONTRACTOR /1/I
ADDRESS r /� /� Q CONNECTION DATA
CITY 4 /k< TEL NO' STATIO
ATE t UPPER
REGISTRATION NO 7 COUNTY WEA
No pDEESCRI F N W RK FEE
OLE REfERENC
PUB LIC SEEWERCON CONNECTING TO IP $3 00 O U k
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PIT!AND/OR SEEPAGE
!00 T CURB P L Y L TO P L
OVERFLOW SEEPAGE PIT DRAIXFIELD
EXTN CESSPOOL ORYWIE LL 100
HOUSE SEWER CONNECTING TO P C N°
V E PO EY Sl 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER S '
A TER RE PA I R OR A BAN DON HOUSE STATE ENCROACHMENT
SYSTEN $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERD'IIT s CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I J REIMBURSEMENT FEE
I HAVE AT RAM90 CON-
TRACTOR TO CIONNETCT THE ABOVE DESCRIBED EXISTA CONTRACT WITH THE IING DWELLING APPROVALS DATE INSPECTOR S SIGNATWIZ
TO THE PUBLIC SEWER
SIGNED THIS DAY OF +9_ NEW HOUSE SEWER
OWNER OR O CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRE— SEPTIC TANK SEEP PIT(SI
AND/OR DRAINFIELD
IN
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWEROR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY OS ANGELES CO AND STATE OF DISCONNECT PLUG AND t CALIF OR THAT 1 THE LEGAL 0 NE OF TtlH ABOVE ABANDON HO EWER
DESCRIBED RESIDENTIAL PERTT BACKFILL SE IC TANKS ❑
SIGNATURE BEE ITS CESSPOO
OF PERM
OF V BTION ROBERT A WOOD
00 lTUP6RVIMING AIECFIANICAL eNOINEMR
f_ya j10. Glr�c,��YV,I�
11 9 45 MAY ?3 1 O A 5.00 e
le
C7"04
"" a e5 APPLICATION FOR PERMIT
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• COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL y
PEPARTMENNT OF COUNTY ENGMM
BUILDING AND SAFETY DIVISION BUILDING 6-712— A/ ! r No L)}
ADDRESS
lO�f 1LLRMlD3 EmLwr
TT D 6HIPPDf.Bq at BoIIdmQ LOCALITY � T
NEAREST
FOR APPLICANT TO IN CROSS BY
LEGAL
DESCRIPTION LOT NO 14 Q A /I OWNER
BLOCK TRACT - I AKA LRESS Al, < t
NO OF BLDG$ ?
SIZE OF LOT NOW OX LOT ...J CI 0
USE OF
BUI LDIN69 kas
DISTRICT NO GROUP MAP PROCESSED BY
CONTRACTOR /
po
k
ADDRESS 2,2W �4 R CONNECTION DATA
CITY �L /K a " TEL o<57 T r q /(QS 9TArloN �c DEPTH
REGISTRATION NO UTAIN Y *PER
NO 1 DgESCRIPT O WORK FEE
PUBLIC EWE RCON NEGTING TO ® Go
SEPTIC TANK SEEPAGE PIT OR TYPE OF C NNECTION LENGTH FROM
PITS AND/OR DRAINFI ELD S9 00 T CURB P L Y L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
N CE SPOOL DRYII�E LL !e00
HOUSE SEWER CONNECTING TO 7 P C NO
PRIVATE D POS E 100 CD IMP NO 3 JOB NO -T
WORK TOTHODUSEI�EWER L06 OR TRUNK PERMIT NO ROAD PERMIT M
00
WERR DIS EPAIR OR ABANDON HOUSE STATE ENCROACHMENT
QSA100 PERMIT NO
INDUSTRIAL
WASTE APPROVAL� � / CHARGES li /
OWNERS PERNRT CONNECTION CHARGE FEE
ADTHOMATION TOTAL FEE < d d REIMBURSEMENT FEE
I HAVE AT DATE AWITH THE HEREINAMED CN.
TRACTOR TO CIONNECT THE ABOVET DESCRIBED EKISTXNG DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEMT- N¢ � BUILDING OR WORK
ADDRESS SEPTICTANK SEEP PIT(S)
AND/OK DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE BEAD THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRTWELL 13
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER ORq-
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT AY PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY 09 ANGELS NTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I THE LEGAK OW ER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT AL PERTY BACKFILL SEPUC TANKS
SIGNATURE SE PIT 9 CESSPOOLS11
OF PERYITT
t'-VALTDATION RO ETRYA WOOD
tt ■ 0. CAeY SUPSRVIDIN6 MECHANICAL SUYCINEER
LACol NAY231 1 A 2 5.0 0