HomeMy Public PortalAbout5268 SERENO DR_Sewer__ r
a a 9 Ga ? APPLICATION FOR PERMIT 1
Gas
OF RUWING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engl000r
County of LOM Angeles FR
NG
JOHN A LAMBIE CouNTY ENGINEER S
m CASSATT D GRIFFIN SUP T GF BUILDING TY
FOR APPLICANT TO FILL IN STT
LEGAL
DESCRIPTION LOT q0 BLOCK TRACTS. /
ADDRESS
NO OF SLOGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE f.B1C— DISTRICT NO GROUP YAP
BUILDDINGS �
BK PG
CONTRACTOR i
T CONNECTION DAT
ADDRESS A
CITY TEL NO STATION DEPTH
LL q �L MANHOLE REFERENCE Q PER
ATE
REGISTRATION 110 D 6 ( � ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OMTION LENGTH FROM •I
PUBLIC SEWER 0 S 3 50 Y P L Y L TO P L
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EKTN CESSPOOL DRYWELL,YANHOLE ® $200 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1 00
PERU IT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM S 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERM s t 00
AUTHORIZATION yOTAL FEE REIMBURSEMENT FEtEe n
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED CON-
APPROVALS DATE INSPECTORSS ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR�E/l'S•t�jJ BUILDING OR WORN
OWNERS AGENT- SEPTIC TANK SEEP PIT(B)
ADDRESS—j AND/OR DRAINFIELD ,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYW'ELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL ROPTV 9EEPFIL fSEPTIC❑CTANKS❑LS
SIGNATURE
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATI. ROBERT A WOOD CHIEF PLBG INSPECTOR
CK Y 0 CAAN
IQ 320IR FEB 17 14 A 450
LAW - -