HomeMy Public PortalAbout9533 KENNERLY ST_Sewer__ T
&9.663 APOL0CA I ION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE-DISPOSAL
Deportment of County Engineer
County of Los Angeles F
DING / 37
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WM.J. FOX. COUNTY ENGINEER ESS C
CASSATT D. GRIFFIN, SUPT OF BUILDING LITY
FOR APPLICANT TO FILL IN EST '0'
,
CROSS ST _
LEGAL
DESCRIPTION LOT NO V OWNER
BLOCK TRACT �3� '�.0 ADDRESSv
NO OF BLDGS
SIZE OF LOT NOW ON LOT ° CITYk .(, TEL NO 0
USE OF /�
BUILDINGS 9 �a DISTRICTGFROUP MAP
% BK PG
CONTRACTOR
ADDRESS >.►� - I i� CONNECTION DATA
4 Jt
CITY TEL NO STATION �. �. DEPTH 6 ,
�., ❑ STATE MANHOLE REFERENCE /'� - ♦ /r PPER
REGISTRATION NO 3 ❑ COUNTY
No DESCRIPTION &F WORK FEE
HOUSE SEWER CONNECTING TO TYP F CONNECTION LENGTH FROM ..q j—
Y _ OCURB PL ML TO PL
PUBLIC SEWER Q $ 3 50 � J—�
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG OR P C NO LO�OC>
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO Z/
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO /01Z)
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 00INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 _ CHARGES
OWNER'S PERMIT s t 00 CONNECTION CHARGE FEE
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AUTHORIZATION TOTAL FEE REIMBURSEMENT FEES
TRACTORHAVE- CONNECTDATE ONTRTHEAABOVECTED WDESCRIBED EXESTINGA DWELLING APPROVALS- V DATE INSP CTOR'S SIGNATURE
TO THE PUBLIC SEWER
49 NEW HOUSE SEWER
SIGNED THIS' —DAY OF "r 19�—
OWNER OR f e- �f' CONNECT ADDITIONAL BUILDING OR WORK
OWNERS AGENT 6 .�r
j� SEPTIC TANK,SEEP, PIT(S)
ADDRESS �' ' / 4"�'�"" /"` P AND/OR DRAINFIELD
I0ACKNOWLEDGE THAT I HAVE READ THI PPLICATION CESSPOOL❑ DRYWELL[3AND 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT L^PROPERTY. E ? BACKFILL SEPTIC TANKS C3/ SEEP PIT(S) 13 CESSPOOLS 'o
SIGNATURE —
OF PERMITTEE
WILLIAM J. FO . COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
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