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Home My Public Portal About9544 KENNERLY ST_Sewer__ A642D 76A642 0-63 APPLICATION FOR PERMI COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �T JOHN A LAMBIE, County Engineer ADDRESS WILLIAM A JENSEN, Sup't of Building LOCALITY c(.. NEAREST FRISO R APPLICANT TO FILL IN CRDSB 5T - LISS LOT NO OWNER �j MAIL _ TRACT �O ADDRESS /�f i e?NOWNO OON LOBLDTS CITY pC� L( TEL NO DISTRICT NO GROUP MAP PROCESSED BY _ BK PG CONTRACTOR / // �- et,"ADDRESS JJJ CONNECTION D"""ATTA CITY TEL NO STATION DEPTH STATE UPPER C REGISTRATION NO OUNTY MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L } PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO 0- PITS AND/OR DRAINFIELD S1000 CO IMP NO JOB NO OV HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S3 00 CONNECT ADDITIONAL BLDG OR gFFIDAVIT wAlv[F I CASEM[MT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD LTJ EXTN CESSPOOL,DRYWELL MANHOLE @ $5 00 HWY OR ST WIDENING CL ALTER REPAIR OR ABANDON HOUSE ' SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERCHARGESS PERMIT s AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '�•J TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HFREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT,1 M THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A GE /DESCRIBED RESIDENTIAL PROPERTY , ABANDON HOUSE SEWER SIGNATURE '/ra/J/�v/'A'_y„r BACKFILL SEPTIC TANKS El SEEP PERMITTE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER LACO,,.1 ,0 3 7:n APR 68 3 D 100-04A CE603- APPLICA ION FOR RMIT 76A 642DD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOWNER 41 JOAN A LANIBIF, Count) E ngmeer COLFNIAN W JENKIYS, Sup't of Building FOR APPLICANT TO FILL IN 7 LEGAL DESCRIPTION LOT NO MAIL BLOCK TRACT ADDRESS I J �' NO OF SLOGS SIZE OF LOT NOW ON LOT CITY f7 r f TEL NO USE OF BUILDINGS _ JDTRICT NO GROUP MAP PROCESSED Y CONTRACTOR BK 92, ADDRESS (`J� CONRECTION DATA TION DEPTH CITY TEL NO LICENSE LICENSE UPPE LI D CLASS HOLE REFEREN E 2051 Ae- NO DESCRIPTION F WORK FEE TYPE OF CONNECTION LENGTH F HOUSE SEWER CONNECTING TO CURB P L M L TO P LPUBLIC SEWER @ $ 5 00 PTI TAN EEPAGE PIT OR PC NOPITS AND/OR DRAINFIELD @ $10 004NE:_ ' JOB NOOHOUSE SEWER CONNECTING TO NK PERMIT NO ROAD PERMIT N I U PRIVATE DISPOSAL SYSTEM @ $ 3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EAS[w E NT RECORD INSTR NO DATE O WORK TO HOUSE SEWER R $ 3 00 H ALT11T_, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM C $ 3 bLEFAbhDHAINIIELD HWY OR ST WIDENING t� E%TN ,CESSPOOL MANHOLE @ $ 5 00 STATE ENCROACHMENT z I'PERCOLATION TEST @ $ 5 00 PERMIT NO INDUSTRIAL WASTE APPROVAL - OWNER'S PERMIT s z 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WIT THE HEREIN AMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE D C JIBED EXISTING DWELLING TO THE PUBLIC SEW / APPROVALS DATE INSPE OR'S SIGNATURE SIGNED THIS L' DAY OF 19 OWNER OR NEW HOUSE SEWER r OWNERS AGENT CONNECT ADDITIONAL ADDRESS �'ff UILDING OR WORK I HFREBY ACKNO LEDGE THAT I HAVE EAD -THIS APPLICATION' SEPTICTANK SEEP PIT(S) ANDIOR DRAINFIELD AND STATE THAT THE ABOVE 15 CORREC AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I M PROPERLY RE ISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED Y OS ANGLES C TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I THE LEG WN R OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOV �'D ESCRIBED RE51 EN IAL R PER ABANDON HOUSE SEWER SIGNATURE OF PERMITT BACKFILL SEPTIC TANKS ❑ ❑ ��I� } ""' SEEP PITS) ❑ CESSPOOLS ALIDATIOIJ.� CK M O CASH/ LACD '� 0 4 6 APR 6 .1.*C)-D '7.0 0 -�