HomeMy Public PortalAbout9514 KENNERLY ST_Sewer__ ,e 76A642D - A■ ■ ���/T\��®� -'- FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer,
County of Loa Angeles BUILDING �j )�
WM. J. FOX, COUNTY ENGINEER ADDRESS / I ijj �. /C 7-1,t,7 CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYFOR,APPLICANT TO FILL IN NEARESTROSS ST.LEGALDESCRIPTION LOT NO. OWNERBLOCK TRACT p`�Q MAILADDRESS �'-Z i�i,.i O, OF BLDGS.
SIZE OF LOT . ,� NOW ON•LOT CITY .TEL NO.
USE OF
BUILDING A DISTRICT NO. GROUP, MAP
r I 1 I BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL NO, STATION .� DEPTH
/�D��j TATE V O n MANHOLE U PERREfERENCE
REGISTRgT N N 41 ❑ COUNTY 7 ]V
Tj TYPE OF CO "ECTION LENGTH FROM O
NO. DESCRIPTION OF WORK FEE Y CURB P L. M L TO P L. /'�
HOUSE SEWER CONNECTING TO mow.
'PUBLIC SEWER (tlI $ 3 50
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM 100 dft
CONNECT ADDITIONAL BLDG OR P NO. /Q JOB. NO.
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 _ TRUNK PERMIT-NO. ROAD PERMIT NO ��
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR '
ITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT 3 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH-THE HEREIN NAMED CON- 7/ - �"����///"`•••
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATUP.E
TO THE PUBLIC SEWER V '/'A`�'���'K'�
SIGNED THIS AY OF 19 NEW HOUSE SEWER y f.�
OWNER - OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESSSEPTIC TANK, SEEP, PIT(S)
I&C op AND/OR DRAINFIELD /
I HEREBY ACKNOWLEDGE THAT I HAVE RE D THIS APPLICATION CESSPOOL❑ DRYWCLL❑
AND STATE-THAT THE--ABOVE 15 CORRECT AND AGREE TO COMPLY 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT. I AM THE LEGAL- OWNER OF THE ABOVE -
DESCRIBE RESIDENTIAL P OPERTY. BACKFILL SEPTIC TANKS[Iil r4.)
O, ' SEEP. PIT(S) 0 CESSPOOLS OF PERM] TEE J -
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
�' 5 4 1 7 3 JUL '7 4 4.55 0 �
BY BY -
` DEPUT7 , •DEPUTY
..UT0 5 44 1.-6� -JUL 3 1 0-0.0 4 A � .{R
BY
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