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HomeMy Public PortalAbout9503 KENNERLY ST_Sewer__ D S&E-669 If-SS APPLICATION FOR PERMIT - 1, S 3 E•8 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Depot' ent of County Engineer County of Los Angeles BUILDING �' JOHN A LAMBIE, COUNTY ENGINEER ADDRESS U �✓ ® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY � FOR APPLICANT TO FILL IN CROSS ST. LEGAL r DESCRIPTION LOT NO S OWNER MAIL J 'BLOCK TRACT ADDRESS " NO. OF BLDGS CITY TEL. NO •SIZE OF LOT NOW ON LOT USE OF DISTRICT NO. GROUP MAP BUILDINGS w e i _ BK , PG CONTRACTOR/'P ADDRESSZla' AA CONNECTION DATA J7 STATION TY , d DEPTH .� CITY EL. N0. '' MANHOLE REFERENCE * - STATE OWER, REGISTRATION NO. Q ❑ COUNTY NO DESCRIPTION bFWdRK FEE HOUSE SEWER CONNECTING TO TYPE OF CON CT10 LENGTH FROM P ' Y. M L TO P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD Q $3.00 'p C N0. Q OVERFLOW SEEPAGE PIT, DRAINFIELD S 106 NO EXTN.,CESSPOOL,DRYWELL,M AN HOLE Q $2 00 HOUSE SEWER CONNECTING TO ©w � PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT NO ROAD PERMIT NO y CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT �- --WORK TO HOUSE SEWER Q $1 00 PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE , OWNER'S PERMIT S 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE - I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AHED CON- APPROVALS DATE INSP,EC OR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESC ED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER _ q ".4�JLc.�•^G� 'so SIGNED THIS DAY O, r 19 CONNECT ADDITIONAL OWNER OR v BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS4�_? — "AND/OR DRAINFIELD I HERAY ACKNOWLEDGE THAT I HAVE IrFD THIS PPLICATION CESSPOOL{] DRYWELL❑ O - - AND STATE THAT THE ABOVE IS CRRECT ND AGREE TO COMPLY " WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR _ PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABA HOUSE SEWER CALIFORNIDESCRIBEDARESRDEN .L6RWAT AM T4NG A___ coR O �,THE �gVE SEEP FILLPIT(S)P❑ CESSPOOL 11 �g� J ,,,, :�,(�• ,ti1t.q.-� _.�..J SIGNATURE 1f'gAt•+ OF PERMITTEE r•1 JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG INSPECTOR CK. EE 0 � CASH s 9 L J<<�c?7 3 ,5 1 U 7.6 6 h L� 9 6 9 JIJiN 7 4 _4.5 L rxz, t �f