HomeMy Public PortalAbout5243 SERENO DR_Sewer__ 7BAusD
see•DIIIV'ISION OF BUMIMGAPPLICATION
AM CSAFSEWER-SEWAGE FOR DISPOSAL 1
Dop=ttn.at of County Englnoa
Comfy of Lon Angailes eu1LDIxG
JOHN A LAMBIE.COUNTY ENGINEER ADDRESS
® GBBATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLI i0BE
REARt du CRO "Br
LEGAL
DESCRIPTION LOT NO IVOW.Ir
/ OWNER
c .xOvd HSG' Of J$ns/ ADDRESS
SIZE OF LOT« '/OA r9JCA0OW OFON LOT SLDG9 CITY TEL NO
USE /T=J DISTRICT NO GROUP YAP
USE O IHN65
BK PG
CONTRACTOR
ADDRESkS CONNECTION DATA
STATION EPTR ofCITIr� EL NOflj6
MANHOLE REFERENCE
A EI
WER-
RHG19TflAT10N NO ^l' (] COUNTY
NO DESCRIPTION OF WORK FEE TNH F
/ HOUSE SEWER CONNECTING TO TYPE O CURB ION LELGTY TO PROM L O /
PUBLIC SEWER @ f S 50
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® f S 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EKTN CESSPOOL DRYWELL MANHOLE ® S 2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM f 1 DO TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® f 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEUCT S 1 00
AUMOR=TION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAYED CON- APPROVALS DATE I INSPEC OR SSI NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER1' NEW HOUSE SEWER ct Wt
SIGNED THIS--/, DAY O 195: CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTICTANK SEEP PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION CESSPOOL[] DRYWELLD
AND STATE THAT THE ABOVE IS 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 I AY PROPERLY REGISTERED AMD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNE OF THE ABOVE
DESCRIBED RESIDENTIAL PR TY BACKFILL SEPTIC TANKS 0
SIGNATURE SEEP PITS) 0 CESSPOOLS
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATI ROBERT A WOOD CHIEF PLBG INSPECTOR
CK Y 0 CATH
6Ep3 O 1 1M OCT 74
- 4.50
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