HomeMy Public PortalAbout9419 KENNERLY ST_Sewer__ DFPARTMEENT OF• Y'COUNTENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUIL-DING ,t �(
ADDRESS �c{+ C.� p,N n.0 r
LOCALITY !t
OR APPLIC_NT TO FILL IN �I C.
BUILDING /� NEAREST
ADDRESS �� CROSS ST. �1 fit? t\-A
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST J A2Z��� �s
CROSS ST. �)o
' RECEIVED BY, _ Ready for Inapectfan DATE ISSUED
OWNERMAIL ry „
ADDRESS �j�S s� �-�• � - USE ZONFJ OCCUPANCY I MAP
• I I BIC, PO
CITY �, TEL.N0.. �— 1
CONTRACTOR
ADDRESS JOB.N0. ^_ Q Q
CITY 45FA�� TELAO.��f p� TRUNK PERMIT NO.
REGISTRATION NO. J��G �� STATES ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. -
PERMIT NO.
BLOCK TRACT INDUSTRIAL ---
WASTE APPROVAL
SIZE OF LOT NO.00 S� NOW ON LOTS CHARGES
USE OF
DI CONNECTIO ARGE FEE
BUILDINGS .►r��'�,m -
N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 �8 RECEIPT NO. E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG:OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER,OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 11.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION t + 0 DEPTH
CESSPOOLDRYWELL ' I ,` , MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY, 2.00 Vii
.HFPEI L'O W E
TYPE OF CONNECTION LENGTH FROM p�
jP LM.L.TO P.L.
OWNERS PERMIT S 1 00 Aly-P, �cCUJiIt
'AUTHORIZATION I TOTAL FEE (� O
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..--.----.DAY OF.•....._ _•__19_19_ NEW HOUSE SEWER 5cCi yp G
OWNER 'OR CONNECT ADDITIONAL
OWNERS AGENT...........---...._......
- - - - - BUILDING OR WORK
- - - - SEPTIC TANK,SEEP.PIT(S)
—ADDRESS...............-......--••--------._.._-._--_.._.._-._--_•-----..•_-_-.-...._.- AND/OR DRAINFIELD `
1.HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL I]
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
d SEEP.PIT(S)0 CESSPOOLS
SIGNATURE I ,(S.
OF PERMITTEE•-------• --r--------- -• - - •---- D
76A642A 663 7/53 Ap& ��