HomeMy Public PortalAbout9545 KENNERLY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENI3INEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILDING
C ,
DDRESS ��( �j Cf le t Q?„} NEAREST
A
CROSS ST C �r
LOCALITY ��. G � DISTRICT N0. A J
SERIAL NO �`P'EQR PERMIT ' C
NEAREST �
ROSS (� O C
CST `�C�
RECEIVED BY Ready for Inspection DATE ISSUED 1
OWNERS CJ �MAIL a
ADDRESS USE 20N�E OCCUPANCY BK MAP PG
CITY TEL NO. � I�Cl t f:ty
CONTRACTOR M. C. Nottingham Co. of TPmnla City
ADDRESS 5933 N. CLOVERLY AVE. X06.No. '3
MPLEMT� CALIF, g�
CITY b• d o].?( TRUNK PERMIT NO. r
/7 STATE o�
REGISTRATION NO COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
���� PERMIT NO
BLOCK TRACT ���'j INDUSTRIAL
WASTE APPROVAL
NO OF
SIZE OF LOT 1„�� I , NOW ON LOTS I CHARGES
USE OF °
BUILDINGS QLD GQ 4t` CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE ` ��
PUBLIC SEWER @ $ 3 50 3 RECEIPT NO. DATE _ BY
HOUSE SEWER CONNECTING TO I .4- 3-
PRIVATE DISPOSAL SYSTEM I W
CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED V
WORK TO HOUSE SEWER 1 00
ALTOR EPAIR EXISTING I _ NO I DATE BY
ER R
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATION t ' Q DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 I MAEFERENCE
53,Z PPER,
YPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 pp b' M L.TO P L. `J
AUTHORIZATION I TOTAL FEE 1 4-5n -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED "w
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE WLIC SEWER I
SIGNED THIS .DAY OF._ -_----- 1q.5-4 NEW HOUSE SEWER S
OWNER OR % ) /� CONNECT ADDITIONAL
OWNERS AGENT `�..J C..� BUILDING OR WORK
�m� �s -���+ _I SEPTIC TANK,SEEP.PIT(S)
ADDRESS -i7__ _fi: a !w_�•� AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS RRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 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 f A`M-THE LEGAL 0
ER OF THE AB9� DCGR.IB A P 0 E BACKFILL SEPTIC TANKS El
SIGNATL'R �/ �y SEEP PIT(S)� CESSPOOLS so- �G
OF PERMIT _._.
76A642D 663 f�O
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