HomeMy Public PortalAbout5134 SERENO DR_Sewer__ 5
T& 66 APPLICATION FOR PERMIT
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DIVISION-QF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
1. D*pmthecit of Connty En
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County of Los Ani BUILDING
•SWM J FOX, COUNTY ENGINEER ADDRESS (iV
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cA�ATT 0 GRIPPIN.SUPT or SUIIDINY LOCALITY
FOR APPLICANT TO I= IN NEAREST w
CROSS Si
LEGAL
DESCRIPTION LOT NO 3 Ai + '. '� OWNER
BLOCK TRACT MAIL Y r
ADDRESS
MO OF Ba&ii
312E OF LOT MOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP I BN MIP
PG
CONTRACTOR
ADDRESS CONNECTION DATA
r
CITY T TEL NO +, STATION q "' DEPTH 4 N.j
STATE REGISTRATION NO �• B�COUMTY orAN REFERENCE "�'' LOWER
TYPE OF ON SECTIO LENGTH FROM
NO DESCRIPTION OF WORK FEE Y P L Y L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® S 330
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL LDG OR CO IMP NO, h JOB M
WORK TO HOUSE SEWE 1 00 / t 4
ALTER OR REPAIR EXI ISO —�— ��
SEWER OR DISPOSAL 3 TEM 1 00 TRUNK PERMIT NO ROAD PEO
RMIT M
DISCONNECT AND ABA DON SEWER STATE ENCROACXYEMT
AND/OR DISPOSAL SYS EY I DO PERMIT NO
SEPTIC TANK,SEEPAG �T OR 1S
PITS AND/OR DRAINF LD t 00 INDUSTRIAL
CESSPOOL-DRYWEL WASTE APPROVAL , A
SPECIAL CONDITIJWMLY i GO CHARGES14
^
9S CONNECTION CHARGE FEE
MIJ
N ' PEaT S 1 00
AUMO TION TOTAL FEE 7 I'= REIMBURSEMENT FEE •T
1 NAYS THIS DATE(CONTRACTED WITH THE HEREIN NAMED CON- ,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR 4SAA7@RE
TO THE PUBLIC SEWER
1
SIGNENEW HOUSE SEWER
DDAY OF, /"T ,x_193._
WNER OR CONNECT ADDITIONAL
OWNERS 4NT 7 BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS ' P AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOLO DRYWELL❑
ANp STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMBING AND SEWERS � j +
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/GA DISCONNECT PLUG AND
LICENSED A.1 REQUIRED BY LOS�NGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEP C TANKS[ISEEP PIT S) CESSPOOLS
SIGNATURE
OF PERU ITTEK ,
Immummommimmmummm—
WIL M FOX.CouNTr,6NawEER VALIDATION -
BY , 4-6 BV 1 18," M 6 a 9.4$ n
DEPUTY DEPUTY
BY By
DEPUTT. �f J✓ � DEPUTY
_) ... _ .� -� -__._. e.... _ -. ... __ t. . fie. .h �. . ' I ♦.- .� .1 I .a.s -.... _. .._.. a,
APPLICATION FOR PERMIT 1
:.DrMON OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL
DopCoont7
of ==,Per
of9dGeBUILDING ,S-/3y'. �3G'. N �Sel-il.o
WM J FOX. COUNTY ENOINMA ADDRESS 36i
CAGGATT D GRIFFIN.9uP T of EHNLEING LOCALITY 14 A 1-4
FOR APPLICANT TO FILL INd
NEAREST /
j CRD59!T ao �O C
DELEGASCRIPTION LOT NO sS _
p x t9 'f- OwNER tyIge J4.
BLOCK TRACT Ris, PAIL
ADORE!! 'tASL
NO OF B DGS
S12E OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS P DISTRICT NOROUP GYAP
= MBK ?I
CONTRACTOR 1 Iy T 6 ,b
ADDRESS p a c /A.. 7 Y--4 CONNECTION DATA
CITY m It TEL NO / STATION F (/ DEPTH
0, TATE MA EFER ENCE
REGISTRATION NO / / ❑ COUNTY A PER LOWER
TYPE NKCm0l . LENGTH FROM
NO DESCRIPTION OF WORK FEE T U P L Y L To P L22
HOUSE SEWER CONNECTING TO 50
PUBLIC SEWER ® $ 330 .7
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
WORK TO HOU EECT I SEWER LOG OR 100 _�p-b CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM too - TRUNK PERMIT NO ROAD PERMIT No's Boa
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
ANO/OR DISPOSAL 9YSTEY oA 100 PERMIT NO
SEPTIC TANK SEEPAGE PIT
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL -- WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGE!
CONNECTION CHARGE FEE
OWNER'S rBHt�r S 1 00
AUTHORIZATION 'TOTAL FSB 7 rb REIIIBURSEYENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED SAISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC JFWER .��
SIGNED THI A O M ISL NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
OWNER! ACEM BUILDING OR WORK
ADDRESS p SEPTIC TANK SEEIELDP,MIT(3)
ANO OR DRAINF
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWKLL❑
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. RfiPA1R,SEWER OR
PLUMBING AND SEWERS ALTER, DISPOSAL SYSTEM
OR
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P PEBTT
BACKFILL 8 G TANKS
SEEP PIT t CKStPO L3
SIGNATURE ' 1
OF PERMITTEE
WILLIAM J FOX.COL47YENcusiffm VALIDATION
NY [�4 8 1 d APR 6 4 75 Q in
DEPUTY DEPUTY
BY By
® DEPUTY i � DEPUTY