HomeMy Public PortalAbout9219 KENNERLY ST_Sewer__ r
24650•INSER- -
`E8088-80 APPLICATION FOR PER9Vli-T • . -.
'7PA64ZD COUNTY OF LOS ANGELES SEWER-SEW,#Gj. .plSP0SAL
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS '
JOHN A. LAMBIE, County En neer
WILLIAM A. JENSEN, Sup't of Building •LOCALITY
'NEAREST /
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL `OWNER
DESCRIPTION LOT N0. •
BLOCK TRACT MAIL- -
ADDRESS
NO.OF BLDGS. -
SIZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF
► DISTRICT NO. GROUP MAP P CESSED BY
BUILDINGS -
�C PG I
CONTRACTOR
ADDRESS , CONNECTION DATA _
CITY l TEL.NO. STATION - DEPTH ••
rSTATE MANHOLEREFEREN UPPER
REGISTRATION NO. COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF'CONNECTION LENGTH FROM -
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. _ M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN. CESSPOOL DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO ` P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 - CO.IMP. NO. JOB
CONNECT ADDITIONAL BLDG"OR TRUNK PERMIT NO. D PERMIT NO. - p
T HOUSE SEWER @ $1.00 V
AEW ER EiiAti�-B1ER4AttDON HOUSE @ $1 00 STATE ENCROA NT - PC
PERMIT N O
INDU IAL V '
WASTE APPROVAL W
CHARGES - N'
OWNERS PERMIT S 2 00 CONNECTION-CHARGE FEE-
AUTHORIZATION TOTAL'FEE REIMBURSEMENT FEE 4
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE,
TO THE PUBLIC SEWER. _
SIGNED THIS DAY OF . 19- NEW HOUSE SEWER
OWNER OR CONNECT,ADDITIONAL
OWNERS AGENT BUILDING OR WORK -
ADDRESS SEPTIC TANK,SEEP.PIT(S) ,
_ AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - - •- - - - -
AND STATE THAT. THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [:1DRYWELL-❑ �
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING' ALTER,REPAIR,SEWER OR.
PLUMBING AND SEWERS - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIF AT 1 AM P PE Y GISTERED AND/OR DISCONNECT PLUG AND -
LICENSED AS .RE D BY LOS GELE UNTY.AND ,STATE F •ABANDON HOUSE SEWER- _ - - • '" '-
CALIFORNIA OR(74&T I AM THE LEG WNER F HE A E
DESCRIBE E IAL PROPERT BACKFILL SEPTIC TANKS ❑ '
SIG NAT SEEP.P,IT(S_ ❑ CESSPOOLS. _ •• _
OF• I
®R ATI ROBERT A. WOOD ;
C14 fd.0.. cps ,••SUPERVISING,MECHANIC:AL ENGINEER
L,&•5 3.9, 1 y ?2 3'0 0 _m