HomeMy Public PortalAbout5133 SERENO DR_Sewer__ APPLICATION FOR PERMIT 1 '
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BAQON OF BMLDUgG AND M= SEWER-SEWAGE DISPOSAL
Dspoz�at of County Eus�
Com1T OI Lm Angeles BUILDING /
WM J FOX.COUNTY ENGINEER ADDRESS
CASBATT D GRIFFIN,BMF'T OF MuILDING LOCALITY
FOR APPLICANT TO FILL IN "RAREST
"on
LEGAL
D CRI ON OT NO Iff ,O OWNER
CT b,. Zi .7 NAIL
ADDRESSNO OF BLD
SIZE OF LOT NOW ON LOTS CITY TEL NO }
USE OF
BUILDIN S DISTRICT NO GROUP 0i/MAP
PG
CONTAACTOR
&r
v
ADDRESS CONNECTION DATA
CITY / Q c P TEL NO A6 s STATION DEPTH
IZ
/� STATE MANHOLE REFERENCE UPPER
REGISTRATION NO / ' ❑ COUNTY LOWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO . TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER ® S 50 Y CURB P L M L TO P L
"OUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONK ECT ADDITIONAL BLDG OR P C 0
WORK TO HOUSE SEWER 100 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT
DISCONNECT AND ABANDON SEWER STATEENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD Z 00 INDUSTRIAL
CESSPOOL"DRYWELL ASTE APPROVAL
SPECIAL CONDITIONS ONLY Z 00 PPIARG
O S PERMIT CONNECTION CHARGE F
f 1 00
AUTHORIZATION I TOTAL FEF REIMBURSEMENT FE
IHAVE N.
TRACTORTTO CONNECT HIS DATE O THE AABOVE CTED WDESCR BED EXITH THE ISTINGIN A DW ELLIO G APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC 66WER
SIGNED TH DA 1NEW HOUECT A SEWER
OWNER IN CONNECT A R WORK " c-
OWN
AGENT -`�— BUILDING OR WORK � OO
SEPTIC TANK SEEP PIT(S)
ADDRES ARD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[I DRYWELL[:IAND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE'OF DISCONNECT PLUG AND
CALIFORNIA OR INA T 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER"`
DESCRIBED RESIDENTIAL P ERTY
BACKFILL SEPTIC TARES
SIGNATURE SEEP PITS CESSPOO
OF FERMI
WILLIAM J.FOX.COLIENGINMEt VALIDATION• Z�-R.A.WOOD CHIEF PLOG INSPECTOR
LA�3' 6Z4N HAS .1 4 2.00