Loading...
HomeMy Public PortalAbout9430 KENNERLY ST_Sewer__ AEFAttr1VIENT OF COUNTY ENGIIVEES SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING.AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS (Z(tj� FOR APPLICANI TO FILL IN LOCALITY \ k- C BUILDING NEAREST n ADDRESS CROSS ST. A, �rcit) LOCALITY DISTRICT Nd. SERIAL NO. PERMIT NO. c NEAREST J A �J�i ZC S CROSS ST, l S RECEIVED BY Ready for Inspection DATE ISSUED OWNER 0YID. -0 4 MAIL USE ZONE OCCUPANCY BK MAP PG ADDRESS CITY TEL.NO. A —( r CONTRACTOR -CB�1'Il7'P:'IQYt 0 C D ADDRESS p +� JOB NO. 3 I 3 g CIT knjTEL.NO. TRUNK PERMIT NO. i \ � '"' S�(ATE REGISTRATION N0. ❑ COUNTY ROAD PERMIT N0. '•���- I LEGA PTtON LOT N0. STATE ENCROACHMENT PERMIT NO. BLOCK TRACT 1&9 ® INDUSTRIAL WASTE APPROVAL SIZE OF LOT N0.OF BLDGS. CHARGES NOW ON LOT USE OF YSC BUILDINGS CONNECTION RGE FEE NO. DES R TION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DA BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CONNECT ADDITIONAL BLDG.OR EXC ION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING- DATE I 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 DEP CESSPOOL—DRY W ELL SPECIAL CONDITIONS ONLY 2.00 MA REFg—RENCE RLCLWER TYPE OF CJLNI CTION LENGTH FROM OWNERS PERMIT � I 00 Y. __./CURB P L. M.L.TO P.L. � AUTHORIZATION TOTAL FEE ©t- 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----------------__-..... NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL L g OWNERS AGENT.................................................. BUILDING OR WORK See Y6 C_ -3 SEPTIC TANK,SEEP.PIT(S) ADDRESS------------------.-.._----•-•--•--------------------_.------_------------------------ AHD/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 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 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)C] CESSPOOLS E] - OF PERMITTE ..__.. ..- t - 76A642A 663 7/53 /�I `