HomeMy Public PortalAbout9412 KENNERLY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICAN TO FILL IN LOCALITY C
BUILDING . 5 NEAREST
ADDRESS ♦ CROSS ST.
LOCALITY ® DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST _ A 2Z ZO1
CROSS ST. ��
RECEIVED BY Ready for Inspection DATE ISSUED/,
OWNER {..►�„ A /� '3— . l,4T
MAIL _ USE
ZJC6�NAE,v ` OCCUPANCY MAP
ADDRESS b ♦ BK PG
CITY TEL N0.
J�
CONTRACTOIR� nG
st Gi�✓� , 9x�C� 0
ADORES a j`! „ JOB.N0.
CITY 84•r_ TEL.NO. �pp� �� ?k TRUNK PERMIT NO.
REGISTRATION NO),/� ��� " � � ���QtiCOUAiTY ROAD PERMIT NO.
LEGAL STATE ENCROACH MEN r-----.�
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT /�,OJ WASTE APPROVAL
INDUSTRIAL
SIZE OF LOT �-�[ N0.OF BLD08.
NOW ON LOT CHARGES
USE
BUILDINGS CONNECTIO GE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER Q ; 3.50 sZ RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO f I�
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. 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 �� S DEPTH
CESSPOOLDRYWELL Q�. ' . r IMANHPPEF,REFERENCE
SPECIAL CONDITIONS ONLY 2.00 ( ``
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I I pp CIP-� M.L.TO P.L.
2
AUTHORIZATION I TOTAL FEE
I 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
SIGNED THIS..__.._.._...DAY OF.__._.-___ 19_, NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_._.._.._.._.._.._. BUILDING OR WORK
- - - - - - - - - - _ SEPTIC TANK,SEEP.PIT(S)
ADDRESS...................._.__..._.........._.-_- --.._......_.._.._.._.._......_... AND/OR DRAINFIELD
CA1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
NON 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS I]
OF PERMITTEE..___.'
76A642A 663 7/53