HomeMy Public PortalAbout5216 SERENO DR_Sewer__ T9"420as APPLICATION! FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGIIMM
EDD.DING AND SAFETY DIVISION AODDRESSS S O
j0EM A. r MM County Pgldv ADDRE
CABBATT D GHIPPBT.SUP f .f BRDdaRG LOCALITY l-,EA4L
NEAREST
FOR APPLICANT TO F= IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT _ V Z— 3 MAIL
ADDRESS
L NO OP BLDGS
SIZE OF LOT / NOW ON LOTI NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP 7UZ,7PROCESSED BY
BK PG
CONTRACTOR ,�C /1
ADDRESS CONNECTION DATA
CITY TEL NO :Ot� D Gp STATION DEPTH
STATE
REGISTRATION NO J COUNTY MANHOLE REFERENCE UPPER
No I DESCRIpp N F ORK FEE LOWER
PUBLIC SEWERCONNECTIN6 TO 3 00 Pt 7!J – �"
g�pTIC T/�NK SEQPATE PIT OR TYPE OF CONNECTION LENGTH FROM
FIT!A ZOggREEDDENA NF IELD $3 00 T CURB P L Y L TO P L
OVERFLOW CSE SPGOL ORY TELL MANHOLE 2 00 �Z ^Z 7
HOUSE SEWER CONNECTING TO P C fl0
PRIVATE DISPOSAL SYLSTEM 1 00 CO IMP NO JOB NO
CONNECT
ORK TO HOUSE SEWEBLDG OR $1 00If,0TRUNK PERMIT NO ROAD PERMIT NO
A TER EPAIR OR ABANDON HOUSE STATE ENCROACHMENT
3 ER R 01l P09AL SYSTEM 1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNM PERM 2 00 CONNECTION CHARGE FEE
AUMOFM77ON TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR 4316NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19. NEW HOUSE SEWERCONECT
OWNER OR
q� /
OWNERS AGENT -Y — BUNLDI G OR WORK ADDITIONAL
ADDRESS SEPTICTANK SEEEP LD PITH) r O_-
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE To COMPLY CESSPOOL FI DRYWELL FI
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR !EWER OR
PLUMBING AND !EWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON ROUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED BESIDEIA PROPERTY BACKFILL SE IC TANKS❑
SIGNATURE PERM
SUP PITS CESSPOOLS
OF PERM
®r_ VALIDATION ROBERT WOOD
CK ■ 0 eAW SUPERVISING MECHANICAL @IGINMMR
(J O4 9 7 0 AUG 12 1 0 D 3 .0 O N