HomeMy Public PortalAbout9408 KENNERLY ST_Sewer__ DEPARTIIENT OF COUNTY ENGLYF.E7i ,I SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGQ NEAREST `
ADDRESSJ� CROSS ST. m
9 .
DISTRICT TRICT NO SERIAL NO. PERMIT N0.
.� ..� � �� A 2_zz..o
NEAREST � „� /�
CROSS ST. Fd F1
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
ADDRAl LESS �t � !►mq . USE ZONE OCCUPANCY BK MAP PG
CITY y TELAO. A— Izt;'
CONTRACTOR
ADDRESS/ s�����GG�� JOB.N0.
CITY ��� }�C,TEL.NO. A� f�J G-F.^d� TRUNK PERMIT N0.
yy STATE
REGISTRATION NO. /�? o� sa B_COUNTV ROAD PERMIT N0. -�
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0.
PERMIT N0.
BLOCK TRACT /�� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTp� N0.OF BLDGS.
C� S�/Y NOW ON LOT CHARGES
USE OF
BUILDINGS „ CONNE CHARGE FEE
NO. , DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT F '
PUBLICSEWER @ $ 3.50 RECEIPT NO. IDA-f I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTION RECORDED`
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING t10' DATE BY`
SEWER OR DISPOSAL SYSTEM 1.00•
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA s
SEPTIC TANK,SEEPAGE PIT OR �� c'
PITS AND/OR DRAINFIELD 2.00 STATION _l DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 'x, MAHHVOPEE,�REFERENCE eat
iTYPE OF CONNECTION ^ LENGTH FROM /
OWNERS PERMIT ; I "OJUBBs �P•_'' M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I ? 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 PUBLIC SEWER L
SIGNED THIS..._.._...........DAY OF..._.....______._._ _.I9_ NEW HOUSE SEWERSc�jYIsGJc 3'
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..............................._..........
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..............-•-.---•----._.._....------•--._.._......_-....._-._.---...__. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL[
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE.SEWER
ER.OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE i / ' /�; SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE - '- - - .. ...............................
76A642A 663 7/53 I" i� 6Fd�I v` t. `� 4 j