HomeMy Public PortalAbout5157 SERENO DR_Sewer__ 1G-Ba
TBAU6'k6cLD APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING `
f0}Q/ A L11M8IE CeYDIw EaplaaLt ADDRESS
WRLIAM A IENSEN 8Ov i F BYildmp
LOCALITY
NEAREST IF
FOR APPMICANT TO FILL DROSS er
LEGAL
DESCRIPTION LOTNO OWNER
MAIL
BLOCK TRACT ADORES,
NO Of BLLOT
SIZE 01 LOT NOW ON LOT CITY TEl NO
US[ Of DISTRICT
NO OROUf MAP R taLD BY
BUILOIMOS
_ BK PP/O/
CONTRACTOR
ADORE" CONNECTION DATA
CITY t T[l NO y STATION �D DEPTH
/� / STAT[ MANHOLE REFERENCE
/ a6
REGISTRATION NO y{.S COUXTY �5 Q LOWER
No DESCRIPTION OF WOR F[¢ TYK OFt oN L¢NOT ROM /
NOUS[SEWER CONNECTING TO A Y CU P L M L TOP L
PUBLIC!EWER • 6500 Cl.
SK"IC TANK SEEPAGE PIT ORP C NO O
PITS AND/OR DRAINPI OLD • $1D oo co IMP No137-7 Job NG V
HOUSE:EWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO K
PRIVATE DISPOSAL SYSTEM • S300 O
CONNECT ADDIT10KAL BLDG ON AFFIDAVIT wuYtt Iota[[ RECORD INS" NO DA L W
WORK TO HOUSE:[WOR • S500
OVERFLOW SEEPAGE PIT GRAINFIELD
SXTN CESSPOOL DRYW[LL MANHOLE 8500 HWY OR ST WIDENING Z
ALTER O PAIR OR ABANDON HOUSE B{WER OR DI/roSAL SYSTEM • 5500 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WAR[APPROVAL
OVINEWS PERMR s z 00
AUTHORIZATION TGTAL FEE CONNECTION CHARGE FEE CHARGES
1 HAVE AT THISDAT[ A CONTRACT WITH THE MERSIN NAMED CON R[IMSURS[M[NT FE[
TRACTOR TO CONNECT THE ABOVE DESCRIBED EIISTING DWELLING nOV
*O
TO THE PUBLIC SEWER AAIv ATF INSPECTO115SIGNA R[
SIGNED THIgj DA OF ip_
OWNER ONAO[NT N[W NOUS:SEWER
OWN[Ra
HOUSE
ADDR968 I OUILDING OR WORK
SKPTICI HERESY ACKNOWL9009 THAT I HAVE READ THIS APPLICATION AND/OR
SFIE PlTlal
ANO/OR piAINFI[LD
AND STAT[ THAT THE ABOVE IS CORRECT AND AWS[ E COMPLY
FLUWITH
ALL COUNTY ORDIMANC[S AND ,TAT[ LAWS REGULATING
FLU MOINO AND BLW[M C[OfPOOL ❑ ORYW[LL ❑
1 HtR[BY CERTIFY THAT 1 AM PROPERLY R[OIR[RED AND/OR ALTER REPAIR B[WEROR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL BYST[M
CALIFRNIA OR T 1 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
O[DID[OIN TN AB [
OZSCMORD RESIDENTIAL PROPERTY
ABANDON HOUSE t[WtR
IIONATUN[
OF P[RMITT[[% BACKFILL SEPTIC TAN" ❑
SCEP P?Iq LI C[NPOOLS
VIUMATION—,—, ROBERT A WOOD
CK I Y O CASH SUPERVISING MECHANICAL ENGINEER
LAGD 8 6 9 3 JAN 11 1 0 0 7.60-