HomeMy Public PortalAbout9424 KENNERLY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER, SEWER—SEWAGE DISPOSAL-`
DIVISION OF BUILDING AND SAFETY I
comvTY of ]LOS ANGELES � PERMIT APPLICATION
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS �Gt �pp ��p-(.I'l
BUILDING FOR APPLICANT 1 FILL IN LOCALITY `C
ADDRESS NEAREST
. CROSS ST. V
LOCALITY
+ DISTRICT NO. SERIAL N0. 3 PERMIT NO.
ry
NEAREST Li>l/ J A S_ S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER r Cl 1ej
MAIL ' USE ZONE OCCUPANCYBK MAP PO
ADDRESS
CITY /� F TELNO. '�t
r`.� .,A�
CONTRACTOR et
'ADDRESS ® n JOB.N0.
CITY J TEL NO TRUNK PERMIT NO. ---^
REGISTRATION NO. COUNTY
ROAD PERMIT NO.
LEGAL ss STATE ENCROACHMENT
DESCRIPTION - LOT NO., (6 PERMIT NO. _.
BLOCK TRACT INDUSTRIAL
f WASTE APPROVAL
SIZE OF LOTISa I` NOW ON LOTS / CHARGES
USE OF
BUILDINGS CONNECT RGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER LDO
ALTER OR REPAIR EXISTING N0. I 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 ANHOLE REFERENCE
�A� [9 UPPER LOWE
TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT $ 1 00 . M.L.TO P.L. 'a •p
AUTHORIZATION TOTAL FEE �/ �''d
CONTRACTOIR TO CONNECT THE ABOVE D SCRIBEDDATE CONTRACTED WITH THE- I EXISTIED
NG APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..-_-_._..-_DAY OF......�_.�.._.__ —19_r.- NEW HOUSE SEWER S /7
OWNER OR
CONNECT.ADDITIONAL -OWNERS AGENT..........._.._.._:....._---......----.._......_.__.._•-•---.... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)•
ADDRESS...-........- - - - - - -.._..-......_._....-._.........._... AND/ORDRAINFIELD
1 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 1 AM PROPERLY REGISTERED AND
DISCONNECT PLUG A
AND/OR'LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG ND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE / 6, SEEP.PIT(S)o CESSPOOLS E
OF PERM ITTEE - '�1.
76A642A 663 7/53 9W;iAAW I