HomeMy Public PortalAbout9413 KENNERLY ST_Sewer__ DEPARTMIENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADOR ESS , F_
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LOCALITY
FOR APPLICANTT FILL IN
BUILDING NEAREST c
ADDRESS ,..Q/j1 ' CROSS ST. C I O V.(!- J�
LOCALITY DISTRICT NO SERIAL N0. PERMIT N0. c
NEAREST N V A Z�I� — J
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER 3—MAIL 1J—J 4
ADD RESS USEZQNE OCCUPANCY MAP
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CITY TEL.NO. A— 1
CONTRACTOR , j (1
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CITY C. •L��ilq ��� TELAO. �)(®� G2 TT 7P TRUNK PERMIT N0__1
REGISTRATION NO. 3G,/ ? �C " j� R,&Af'TV
ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO. ------
BLOCK TRACT / INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NOW ON LOTBL S ! CHARGES
BUSE OF
UI DINGS / strQ , CONNECT CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENTF
HOUSE SEWER CONNECTING TO g�
PUBLICSEWER @ $ 3.50 V RECEIPT NO. ATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDE
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 Q DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 3iS I MAUPPE EFERENCE
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I oo i=_E M.L.TO P.L.
AUTHORIZATION I T&AL FEE
IHAVE 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 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT..........._.-_.._......_._....
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOUSE-SEWER PLUG PLUG AND
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)C:] CESSPOOLS Q
_-_---.--
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