HomeMy Public PortalAbout9520 KENNERLY ST_Sewer__ DEPAKI'MENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
--D VISION OF BUILDING AND SAFETYPERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING -
WILLIAM J. FOX, COUNTY EN13INEER ADDRESS �.�'aD L� /�IIV45 �40
FOR APPLICANT TO FILL IN LOCALITY T�C'iJ
ADDRESS BUILDING fEAREST
k, ew-AeCROSS ST e-
LOCALITY
i
���1 / n, DISTRICT NO. 'BERFAt 7- PERMIT NO.
/ G� _ 9`'� �p c
NEAR ST 6/0
� ! `' 70 237 0 J
!J q� RECEEIIV iYB 7' Ready for Inspection s DOE ISSUED
J
OWNER >�/C�/9�y f�60 �r/ lIG0 3'®A�
MAIL � 4 O , j/��� er�� �� i USEZOa OCCUPANCY K
ADDRESS r L. /C Pn
CITY T�7 /1� CI PI` TEL.NO. �/• V 3 G I I �� BK
CONTRACTOR
ADDRESS JOB NO.
C'
CITY TEL NO. TRUNK PERMIT NO
STATE
REGISTRATION NO B COUNTY
ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO
BLOCK TRACT . "�� INDUSTRIAL
't_ WASTE APPROVAL
SIZE OF LOT�.S /47_NOW ON OFBLOTS CHARGES
USE OF _[�
BUILDINGS �y CONNECTION CHARGE F E
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER Q $ 350 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR �/+] CEPTION RE ORDED
WORK TO HOUSE HEWER 1 00 V
ALTER OR REPAIR EXISTING N0 I 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/0R DRAINFIELD 2.00 STATION j Q DEPTH
CESSPOOL—DRYWELL a
SPECIAL CONDITIONS ONLY 200 --UPPER
00hl--UPPE_eFccRFNCE—
UPPER R'
TYPE OF CONNECTION LENGTH FROM
OWNERS • PERMIT $ 1 00 Y
AUTHORIZATION I TOTAL FEE Z epe /Z
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 y�
SIGNED THIS.S�'O------DAY OF... -_. 19*!-- NEW HOUSE SEWER
OWNER OR BUI1LDINGORECT ADDITIONAL
SG ir�G�
OWNERS AGENT- •----•---•------...---• -----•---_.._---.._......_.-_.._-�
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-------------_
-•--••--- ----•- - - - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[-] DRYWELL E]
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 ESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS E]
SIGNATURE �A SEEP.PIT(S)F] CESSPOOLS 0
OF PERMITTEE- � ✓
Im
76A642A 663 7/53 O! �