HomeMy Public PortalAbout5211 SERENO DR_Sewer__ DEPAKTMMNT OF COUNTY ENGINE= SEWER--SEWAGE DISPOSAL
( DIVISION OF MILD= AND SAFETY PERMIT APPLICATION
COUNTY OF 1.09 ANOEF
WILLIAM J. FCX. COUNTY CNQIN[[R BUILDING
ADDRESS J /
FOR APPLI T TO FILL-IN LOCALITY
BODflE88 G7� —
uiLOINa CROSS Q<5>�D /LGZfGp2Cs[ m1
LOCALITY � DIBTRIOT NO. SERIAL NO PERMIT NO '
NEAREST CQ A S
CROSS ST
pECEI E BY RadY TM Iarynlle0 DATE ISSUED
OWNER ^ / _f -.
MAIL USE ONE OCCUPANCY (GJ MAP- ✓
ADDRESS BK Pa
CITY �� EL NO
CONTRACTOR � CO IMP NO
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ADDRESS / L P /� -_ `� /L�
Gr y JOS MO
CITYe2 %....-ci.TEL NO TRUNK PERMIT NO
TATE
REGISTRATION NO COUNTY ROAD PERMIT NO
LEGAL _
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO —
BLOCK TRACT
3 INDUSTRIAL
NO OF BLD88 WASTE APPROVAL✓
SIZE OF LOT NOW ON LOT 7 CHARGES
USE OF
BUILD,NOB ZZ-:5E-e- CONNECTION CHARGE FEE
noDESCRIPTION OF WORK FEE t
HOUSE SEWER CONNECTINO TO REIMBURSEMENT FEE -
PUBLICSEWER ® t SSO RECEIPT NOT
HOUSE
BY
OUSE SEWER CONNECTING TO ��
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR_. _ EXCEPTION RECORDED - -
WORK TO HOUSESEWER
10D
AL EROR REPAI R EXISTING NO DATE
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AMD/OR DISPOSAL SYSTEM I DO CONNECTION DATA
PTIO TAN ,SEEPAGE 'R
PITS AN 0/0
GRAINFIELD IM STATION �� DEPTH'
CE DOL—DRYWELL ,/n / c AN
SPECIAL CONDITIONS ONLY 200 �T /71 •y UPPEER
EFERENCE
N
EIO p
OWNERS E08NV 0 TL
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER ,, APPROVALS INSPECTORS SIGNATURE DATE
I -
SIGNED THIS——DAY OF 11 j NEW HOUSE SEWER 7 3;x
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
�I SEPTICTANK SEEP PIT(8)
ADDRESS - f AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 ORYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY O8DIMANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERSSEWAGE DISPOhiL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED, DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AMD STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ACKFILLSEPTicTANK i
810NATURE BEEP PIT($)[] CESBPO0 17
OF PERMITTEEIA
T016UO) 6N 1/68 I