HomeMy Public PortalAbout9431 KENNERLY ST_Sewer__ APPLICATIORTOR PERMIT
'IS&E•663 12.54 -
DiVISION OF BUILDING AND SAFETY SEWER—SEWAGE D 1 S POSA L
Department of County Engineer
County of Los Angeles
'j WM. J. FOX, COUNTY ENGINEERJ_7ACASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT j� MAIL
�@ ADDRESS -
SIZE OF LOT 66� N0. OF BL NOW ON LOT T ADD
TEL. N0. e,P
USE OF
BUILDINGS DISTRICT N0. M
P
GROUP
4 I B ,PG/
CONTRACTOR -
ADDRESS CONNECTION DATA �-
CITY STATION DEPTH
STATE
REGISTRATION NO.-
�JL qj�• ❑ COUNTY MANHOLE UPPER REFER .LOWER
TYPE OF CONNECTIONLENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L. �+
•HOUSE SEWER CONNECTING TO
PUBLIC SEWER - Q $ 3.50
HOUSE SEWER CONNECTING TO A.p� -1'ydoy DSS' _
PRIVATE DISPOSAL SYSTEM 1 00 �{�/� J
WORK TO HOUSE CONNECT I SEWER ONAL BLDG. OR 1.00 >t/ "� CO, IMP. N0: d> per-w+
ALTER OR REPAIR EXISTING '
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
•DISCONNECT AND ABANDON SEWER STATE ENCROAC T
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO
,SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION C RGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE' ID 0 REIMBUFjB MENT FEE
IHAVE CON-
TRACTOR TO CONNECT THECTED ABOVEWITH THE DESCR DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER . _
NEW HOUSE SEWER
SIGNED THISDAY OF - 19��
OWNER OR ( / r CONNECT ADDITIONAL
OWNERS AGENT /J 1✓�/ BUILDING OR WORK
SEPTIC TANK. SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE REJTHIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT•AND AGREE TO COMPLY -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
ABANDON HOUSE SEW
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE �
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
2.00 m
ray
,y B •5� CRY 3:1 4
DEPUTY ++ - _ DEPUTY
BY BY
-® DEPUTY vDEPUTY