HomeMy Public PortalAbout9409 KENNERLY ST_Sewer__ DEPARTMEA'T OF COUNTY ENGnvF" SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT .APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS (:R 4�.dq C prr(�R►lw 6� ,
FOR APPLICA,T TO -FILL IN LOCALITY
BUILDINGv p �- NEAREST
ADDRESS J�7 % -14 CROSS ST. CA ` LA
LOCALITY DISTRICT N2)).. SERIAL NO. PERMIT NO.
NEAREST 2a1C l
CROSS ST. , w
�f/, RECEIVED BY Ready for Inspection DATEISSUED
OWNER 1 WOLA-0��..:. " 3- 1u-"4-
MAIL 30 � , USE ZONE OCCUPANCY BK MAP PG
ADDRESS 0
CITY TELAO. ..
CONTRACTORS
ADDRESS JOB.N0.
CITY �„11� TEL.NO. �nn� ❑j�,�r TRUNK PERMIT NO. ®-
REGISTRATION NO. ` Ta �EOt1NE ROAD PERMIT N0
TY .
-LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT > �Q�' INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDG8.
�' NOW ON LOT ) CHARGES
USE
BUILDINGS �,(� C/� CNNE N CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEME EE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR E TIONRECORDED
WORK TO HOUSE SEWER 1.00 NO.
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 Z {-,-Nin DEPTH I
CESSPOOL-DRYWELL t MAN �EFERENCE
SPECIAL CONDITIONS ONLY 2.00 A^ EJ
K o PPE
PI _LOWER
TYPE OF CONNECTION s� LENGTH FROM I
QE' 4`tl88. (P..L. M.L.TO P.L. Z�
OWNERS PER ; I I !00
AUTHORIZATION TOTAL FEE ;710
HAVE THIS DATE
CONTRACTOR TO CONNECT THECONTRACTED
ABOVE DESCRIBED WITH THE HEREI
ECRIBEDI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....... OF..__.-_ ._.___.__-__19 .. NEW HOUSE SEWER SSG YDG a
CONNECT ADDITIONAL '
OWNER OR BUILDING OR WORK
OWNERS
SEPTIC TANK,SEEP.PIT(S)
ADDRESS---.------------------ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL[:] 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUG AND
AND STATE.OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE ���� ^� � (-�✓�- � Cy� SEEP.PIT(S)� CESSPOOLS t
OF PERMITTEE.0S..�_�:--------_� _ Q G
76A642A 663 7/53 -141- 1 G'4 ' �, j