HomeMy Public PortalAbout9418 KENNERLY ST_Sewer__ DEPARi➢I OF COUNTY F2NGINE:ER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENQINEER I BUILDING
ADDRESS K
FOR APPLICA T TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS /�• CROSS ST.
LOCALITY aA DISTRICT NO. SERIAL NO. PERMIT/NCO.
NEAREST V ��'Z0�9 _
CROSS ST. , � �—
RECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
ADDRESS �U '� - USE Z E OCCUPANCY - MAP
BK PO -
CITY ��� TEL.NO.
CONTRACTO `
ADDRESS JOB.NO. 4I—— (P (0 0
Y �L7
CITTELAO. Q� .�� ,y TRUNK PERMIT N0..STATE
�r lJ +
REGISTRATION NO. `` �, '�+ C m VIP-COUNTY
ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT NO. 7 PERMIT NO.
BLOCK TRACT INDUSTRIAL/ 0 ' WASTE APPROVAL
SIZE OF LOTN
s yx i ` OW ON-LOT S CHARGES
BUILDINGS USE CONNECTIO RGE FEE
,..
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER S 3.50 Gd RECEIPT NO. IBY
HOUSE SEWER CONNECTINGTO
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 ;C) - DEPTH
CESSPOOL—DRYWELL -
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
LOWE
TYPE OFCONNECTIOP.L. LENGTH FROM
�sr3� ,�� M.L.TO P.L. �,.
OWNERS PERMIT s I 00
AUTHORIZATION I -TOTAL FEE - _
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 ,
SIGNED THIS------ OF___._._.__ ________19_.—_ ' NEW HOUSE SEWER, _
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[] 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 HOPLUG PLUG AND
'AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
�y -e "U
SEEP.PIT(S)� CESSPOOLS J
SIGNATURE ,�'/
OF PERM ITTEE-_._._.._.._�_.!.-..-.._.__
76AG42A 663 7/53 4T04A&V%-I1l.L ,
D
CE808 a-se - APPLICATION FOR PERMIT' - •`
seoe - COUNTY OF LOS,ANGELES
SEWER-SEWAGE DISPOSAL,
DEPARTMENT OF Lmmmmmj
ENGINEER
BUMDING AND DIVISIONLDING
RESS
JOHN A. LAMBIEngineer
CASSAIT D. GRIFof BuildingALITY
REST
FOR APPLICINSS ST:
LEGAL '
DESCRIPTION LOT NO. OWNER _
BLOCK TRACT MAIL
ADDRESS
0.OFBLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS- DISTRICT NO. GROUP BK MAP I P CESSED BY
e0� PG C F
CONTRALTO
ADDRESS CONNECTION DATA
CITYTEL.N0. STATION DEPTH- .
TATE MANHOLE REFERENCE UPPER
REGISTRATION NO. 1,47 7 COUNTY LOWER
NO. I � DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $100
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECT N LENGTH FROM
PITS AND/OR DRAINFIELD @ $ .00 Y. CUAB P.L. M.L.TO'P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
Z -15
EXTN_CESSPOOL.DRYWELL @ $ .00
HOUSE SEWER CONNECTING TO _ -P.C.N0. -
PRIVATE DISPOSAL SYSTEM @ $ 00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERM 0. ROAD PERMIT N
WORK TO HOUSE SEWER @ $ 00 i
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMEN
EWER OR DISPOSAL SYSTE @'$ 00 PERMIT NO. -
INDUSTRIAL - - -
WASTE APPROVAL
CHARGES
OWNERS PERMIT 51 Z 00 CONNECIZ115HARGE FEE
AUTHORIZATION TOTAL FEE rjlyl REIMBURSEMENT FEE
I HAVE AT THIS,DATE A CONTRACT WITH THE HEEINAMED CN-
TRACTOR TO,CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
'TO THE PUBLIC SEWER.
SIGNED THIS DAY OF19-
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK '
ADDRESS- SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .CESSPOOL ❑ DRY-WELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ! �y
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT
HOUSE D
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER ,OF THE ABOVE
DESCRIBED,RESIDENTIAL PROP T . BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
®� ROBERT A. WOOD
/VALIDATION
M.p. CASH SUPERVISING MECHP.NICAL EN6lNEEIi
LAUD 1 4 0 APR 1 Ci 0 .0