HomeMy Public PortalAbout5152 SERENO DR_Sewer__ APPLICATION FOR PERMIT
TGA:AXD
8*E�DMSION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL
DGpcwtmBw of County EugIYB.T
Co®tp of E. Aag.X BUILDING
WM J FOX, COUNTY ENOINBER ADDRESS
CASSATT D ORIFPIN. SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN MEAR[ST
CROlS ST
LEGAL rr'''',, 'p /
DESC APTION LOT NOLJ h P—� OWNER
BLOCK TRACT MAIL
ADDR
NO OF BLDGS
SIZE OF LOT 7 NOW ON LOT CITY-7—,#-'7. TEL NO
USE OF
BUILDINGS OIlTRICT NO I GROUP YAP
CONTRACTOR BK PG
ADORES CONNECTION DATA
CITY TEL NO I STATION DEPTH /
STATE YANHO E REFERENCE
REGISTRATION NO ❑ COUNTY OWER
TYPi NNECTION LENGT ROM
NO DESCRIPTION OF WORK FEE Y R Y L TOP L
HOUSE!EWER CONNECTING TO
_PUBLIC SEWER ® $ 3 5
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO
WORK TO HOUSE SEWER 1 00 __
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL —— WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARGES
0 �8 PEW= f ; CONNECTION CHARGE FEE
00
AUTHORMATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- •�n
TRACTOR TO CONNECT THE ABOVE DES ED EXISTING DWELLING APPROVALS DATE INSfECTOR S SIGNATURE
TO THE PUBLIC ! ER !
/-� NEW HOUSE SEWER i 1
SIGNED THI DAY OF !�2
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDpESAMD/OR DRAINFIELD
! SEPTIC TANK SEEP PIT(S)
1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRTWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELM COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT Tye LE OWNEA OF THE ABOYE ABANDON HOUSE SEWER
DESCRIBED RESIDENT P/✓�R1T BACKFILL BE C TANKS❑
'EEP PIT 9 CESSPOOL! 1\ ll$
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINam VALIDATION
1 0 9 O&, -OM21 4
,EY _ _ _ BY
DEPUTY ///�/�' DEP_ UTY
By BY
m DEPUTY• L//'C` DEPUTY
COUNTY OF LOS ANGELES TEMPLE CITY A' 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE 0508 9608130006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA ,
PHONE (818) 285-0488 EXT
LEGAL ID SEWER SEPTIC S BUILDING ADDRESS
ON FILE EXIST OCC GRP 5152 SERENO DR
BLDGS NOW ON LOT TEMP CA 917803041
ASSESSOR INFORMATIUN NUMBER CONNECTION TYPE NEAREST CROSS STREET' ROSEMEAD BLVD
5388-011-007 ORIGINATION THOMAS PAGE 596 _GRID _H5._LOCALITY -TEMPLE CITY
LENGTH ML TO PL STATION DEPTH: -
TENANT MANHOLE REFERENCE UPPER/LOWER. ISSUED ON PROCESSED BY EXPIRES ON
COUNTY IMPROVEMENT NUMBER 08/13/96 - - - TC- - _ 08/13/97 ^
'
OWNER
_ , PLAN CHECK NUMBER: I I HAL f`1,_,, FIkALp
^
WU HENRY H,JULIAN H -- (818) 286-0943- JOB NUMBER
5152 SERENO DR TRLDIK PERMIT NUMBER ;r -
TEMP 917803041 ROAD PERMIT NUMBER F -
AFFADAVIT NO REPLACE MAIN SEWER ON PROPERTY
WAIVER NO
APPLICANT- TEL NO EASEMENT. NO
NORA, MICHAEL (NEW OWNER) (818) 285-8305- '
RECORD INSTRL14ENT NBR1RECORD DATE SPECIAL CONDITIONS'
—
HIGHWAY/STREET.WIDENIYG F- 0
STATE EN{CRNA vTEPERMIT-NUIBER
CONTRACTOR. FEES PAID DATE INSPECTOR SIGNATURE
RESCUE ROOTER - COVINA (800) 869-6942- � "`/��\ �w
681 SAN BERNARDINO LIC NO FEEEDESCRIPT�IO OWNTITY• UAMO(AIT NEW HOUSE SEWER
COVINA, CA 91724 C42 8 • ,,,,.J / fV"
01 PERMIT ISSUANCE FEE \ 27 75 CONNECT ADDITIONAL
15•ACT/REP HOUSENSEWER 1 00 EAC 430 30 BUILDING OR WORK
ARCHITECT OR ENGINEER . TOTAL FEES 58 05
- SEPTIC SEEPAGE PIT
LIC NO ,�i�,� AND/OR DRAIN FIELD
SEWER MAP BOOK. PAGE PUBLIC WORKS
SEWAGE DISPOSAL SYSTEM
■�■ co DISCDNNEE;T PLUG AND
ABANDON HOUSE SEWER
4/, O SEEP. PIT _ CESSPOOL _
service
• ADDITIONAL DATA ON FILE
_ REPORT ID DPR266 ROUTE TO BS0508 '