The URL can be used to link to this page

Home My Public Portal About5272 SERENO DR_Sewer__ E[°42D APPLICATION FOR PERMIT {� CKSOB D IJ COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPABTMENT OF COUNTY ENGDVEEIi BUILDING AND SAFETY DIVISION BU'LDING 02 ]OR71 A LAmm CeuatT EQ ..T ADGR[.. WUdIAE6 A. IENSEN Sup I d 1-14mv i LOCALITY NIAq{O FOR APPLICANT TO FILL IN CROS[ ST LEGAL, /� DESCRIPTIN LOT NO C OWNER ,cs Sa z MAIL , nocn TRACT AOGR[ee No Or BLDae 812! Or LOT NOW ON LOT / CIT' L NO USt Or DISTRICT NO ROUT RK MAR PC PROCESSED BY Bu1LDmaB CONTRACTOR jM \,,,Q ADDR CONNECTION DATA CI TEL NN20 TATION D[ITH ANHOLE REFERENCE REGISTRATION NO _ J NO DESCRIPTION OF WORK FEETYPE OF GTION LENOTH R HOUSE SEWER CONNECTING TO C RB PL ML TO RL PUBLIC SEWER ® $000 SER IC TANA SEEPAGE PIT P C NO O IMP NO �� DOB NO d PITS AND/OR GRAINFIELD f) [1000 0 OUSE SEWER CONNECTING TORUNK PERMIT NO ROAD PERMIT NO (J PRIVATE DISPOSAL SYSTEM ® Se 00 CONNECT ADO ITIONA DG OFFIDAVIT ..I.EE Eul.[.rt RECORD INBTR NO DATE OC WORK TO HODS[SEWER O poo O OVERFLOW SEEPAGE PIT DRAINFI[LD r XXTN CESSPOOL DRYW ELL MANHOLE O SEW y/ ALTER R ABANDON WY OR ST WIDENING SEWER OR DISPOSAL SYSTEM SSW d TAT[ENCROACHMENT ERMIT NO Z NDUSTRIAL /3.zoASTE APPROVAL CHARGES O S PESMIT fAUTHOFMTION TOTAL FEE ONNECTION CHARGE FE[ I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FE[ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING II ALf1fDOVALS TO THE PUBLIC S[W[R WR DAT[ INH[ OR E SIGNATURE SIGNED THIS DAV OF 18_ OWNEROR NEW NOUS6 SEWER OWNER W X6R6 AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK eEPTIC TANK BEEF PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE V[ READ THIS APPLICATION AND/OR GRAINFIELD AN STAT[ THAT THE ABOVE le CORRECT AND AOA[[ TO COMPLY WITH ALL COUNTY ORDINANCES AND BTATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYW[LL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR S[W[R OR LIC BE AS REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SMACK DISPOSAL BYET[M CALIFORR IA OR "AT 1 AM THE LEO OWNER OF AND INTEND TO DI SCONN[CT PLUG AND R[SIO[ IN THE ABO [ DEB ]BUD BID[NTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TAN" ❑ OE[F PIT(8) ❑ CESSPOOLS VALIDATION ROBERT A WOOD CK M G CASH SUPERVISING MECHANICAL ENGINEER � p5 9 9 6� HOV23 1 D 5.00~ 9 DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DMSION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES __2 7 WILLIAM J. FOX, COUNTY ENGINEER AODRO ✓ / L Sf.�fua G.1 FOR APPLICANT TO RLL IN LOCALITY G� ADDRESS 5�-7A H. SEKE.Vo Lk? CROSS ST O�•OG>'/i9Y BUILDING LOCALITY 7EM/�LE cJ OISTRI NO SERIAL NO PERMIT NO NEAREST JJrjQ'IJ�k/A,/ Y. oSEAyEAD a�yA A Z.S��'�S CROSS ST /J!C 7 RE V�Y RN4/M IOWKtIOp DA�U OWNER cNVECs/ g CNPisT' _ ADDRESS ( ,4S /T/7O✓''J AIL USE ZON OCCUPANCY BK PG CITY TEM PL E C P'rY TEL.NO 019M 117- 1�5 Z p CONTRACTOR �j'r(F 00.INP NO —/d ADDRESS JOIL NO CITY TEL NO TRUNK PERMIT NO STATE REGISTRATION NO COUNTY ROAD PERMIT NO LEGAL / DESCRIPTION LOT NO 7 Lo Z STATE ENCROACHMENTPERMIT NO BLOCK �TJ( G—��- INDUSTRIAL WASTE APPROVAL BIZ!OF LOT l2 6 6 M,O1W OM LO-Tan Z CHARGE BUILDINGS C�✓��N A✓OJrAfi✓M CONNECTION CHARD EE NO DESCRIPTION OF WORK FEE HOUR SEWER NNECTIp O REIMBURSEMENT FEE PUBLICSEWER N $ SEO RECEIPT NO GATE IBY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CORNS ADDITI M L BLDG R EXCEPTION CORDED WORK TO HOUSE SEWER 1 00 0 O NO ALTER OR REPAIR EXISTING DAT BY SEWER OR DISPOSAL SYSTEM 100 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR ^� PITS AND OR DRAINFIELD 740 STATION ` t �� a DEPTH CESSPOOL-DRYWELL SPECIAL CONDITIONS ONLY 700 LOWER I Y TYPE OF CONNECTIDIL_PT JEtlDIILFonr OWNERS PERMIT $ 1 1 00 Y01 L AUTHORIZATION I TOTAL FEE 2 ao yiTia.v�L a 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLID SEWER SIGNED THI DAY OF 19.7.E NEW HOUSE SEWER OWNER OR / CONNECT ADDITIONAL _ OWNERS ABEN w� c /• BUILDING ORTANN,WORK SG C 6 ADDRE� �LC��Tic� S. V_t AND/ORDRAINFIELD PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL 0 DRYWELL GREE TO TION ANDCOMPLY STATE ITH ALLHCOUNTY ORDINTHE ABOVEANCES AND STATRECT ANDE LAWS REGULATING PLUMBING AND SEWERS ALTER REPAIR Y 1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED SEWAGE DISPOSAALLSYSTEM TEE M AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN. ABANDON HOUSE SEWER ER OF THE ABOVE ESCRIBED RESIDENTIAL PROPERTY BACKFILL 10 TANKSn SIGNATURE BEEP PIT(S)[] CESSPOOLno OF PERMITTEE m� MMM reAs+zs eea r/cs A-r-�" CEBOB 1 B! APPLICATION FOR PER IT(,�.PJI,(l�y�,p CEA 862 D S'E COUNTY OF LOS ANGELES SEWER— WAGE SPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LANHIk Count! FuSin, ADDRESS y Z COLLNIA.N W IFNIJ\S Sup t of Building LOCALITY NEAgEBT FOR APPLICANT TO M IN CROSS ST LEGAL DESCRIPTION LOT NO OW N[R ) MAIL BLOCK TRACT /�> .7 H�� /� ADDRESS y Z NO OF SLDOS �� SIZE OF LOT NOW-ON LOT CITY TEL NO USE OF DISTRICT NO OROU MAP ROCEBB[O BY 8U ILDINba 8K /PIS CONTRACTOR N O / / ADDRESS ��V// CONNECTION DASA CITY ✓ TEL NO ..-. Q STATION O[RH LICENSF� ` LICENSE UPPER NO L �� CLASS ` MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM NOU!E SEWER CONNECTING TO Y CURB PL ML TOPL PUBLIC !EWER B f S 00 PC NO PITS AND/OR GRAINFIELD K $10 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM B f 3 00 THUNK PERMIT XO ROAD PERMIT NO U CONNECT ADDITIONAL BLDG 00 AFFIDAVIT I WAIVE. {A(lRlKi RECORD INETR NO DhT[ O WORK TO HOUSE SEWER 4 f 3 00 SEWER TanjosaW SYSTEM F f 3 00 MWY GRIST WIDENING 6444EEE E(TN CESSPOOL MANHOLE Q f S 00 PNCROACMMENT PERCOLATION TEST @ x f B OG _PERMIT NO INDUSTRIAL L :3 2 Q WASTE APPROVAL O Le (/ CHARGES N� I PERM s z oo CONNECTION CHARGE FEE AUTHOR=TION I TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED ERISTINO DWELLING APPROVAL$ TO THE PUBLIC SEWER DATE INSPECTOR 8 SIGNATURE SIGNED THIS DAV OF 19_ OWNER OR NEW HOUSE SEWER OW NERS AGENT CONNECT ADDITIONAL AGGRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK BEEP PITISI AND STATE THAT THE ABOVE la CORRECT LRKOISTERED O COMPLY AN DRAINFIELD WITH ALL COUNTY ORDINANCES AND STAGULATING PLU Ma ING AND SEWERS CESSPOOL ❑ DRYWELL ❑ HERESY CERTIFY THAT I AM PROPERLANO/OR ALTER REPAIR SEWER OR LICENSEO AS REQUIRED BV LOS ANGLES CSTATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM THE LEGAL OWNNTEND TO DISCONNECT PLUG ANDRESIDE IN THE AB DESCRIBED RESIDENTY ABANDON NO UBES[W D SIGNATURE f"� BACKFILL SEPTIC TANKS OF PERMITTEE S[EP PIT(S)SE ❑ CESSPOOLS ❑l R IVALMATIONwsH LAL,O4 9 7 0�8 SEP 2 7 11^ 0 D 5.00" b A—