HomeMy Public PortalAbout9403 KENNERLY ST_Sewer__ i
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS 9 40->N VkZ a r,V-VA/LA
FOR APPLICANT TO FILL IN LOCALITY_'j'j (:Z' ,
BUILDING NEAREST
ADDRESS 1163 CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO! PERMIT NO. c
NEAREST ��/ A -���Cn" J
CROSS ST.
- RECEIVED'DY Ready for Inspection DATE ISSUED
OWNER
�. /MAIL � �, _.
ADDRESS ��,.Z �� V4AL.cq.Li$ /Z '_ USE ZONE OCCUPANCY BK MAP PO
CITY TEL.NO. �- \
CONTRACTOR
ADDRESS 1;P/•
JOB.NO. F=- C.-I❑ 03�1/
m-
A
CITY yTE�L.NOO.a Q� �2_7 TRUNK PERMIT NO.
REGISTRATION N0. /�,,,i e..4o "` - V.W '� L ROAD PERMIT NO.
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMITAO.
BLOCK TRACT J 9 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS. CHARGES
4 Y � NOW ON LOT
USE
BUILDINGS ;� CONNECT CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLICSEWER (A >Z 3.50 L5 4 RECEIPT NO. TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0.
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 --
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION a �-1�� O DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 1 M L'EER. EFERENCE
8 �� E UM
_) '�4VERv.
_TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ o0
I r-y= ARB �P.L M.L.TO P.L. Z�
I
AUTHORIZATION TOTAL FEE JPO
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER rr-�
SIGNED THIS..--.-..----DAY OF___._ 19___ NEW HOUSE SEWER -
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT._.._..._______...__ ._.__ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..........._..__._.._......_.........._.. __.._r...----•--....._.._..__._... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL E3CATION AND STATE THAT THE ABOVE I8 CORRECT AND AGREE v
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER. REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ,DISCONNECT-PLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSESEWER
ER OF THE ABOVE ESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKSE]
Com ^ SEEP.PIT(8) CESSPOOLS SIGNATURE ���f¢�
OFPERMITTEE---------._.................. .......--•----...__..._...---...._ t
76A642A 663 7/53