HomeMy Public PortalAbout9556 KENNERLY ST_Sewer__ 79A642D
CE908 8.89 APPLICATION FOR P tR IT
COUNTY OF LOS ANGELES SEWER-SEWAGE �SP®SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDINBUILDING AND SAFETY DIVISION ADDLD RE SG .� ��
JOHN A. LANMIE, County Engineer `
CASSATT D. GRIFFIN, Supt of Building LOCALITY E
.. _ ,. - NEAREST J
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL G OWNER
DESCRIPTION LOT NO ,t 0 ,{ .
BLOCK TRACT MAIL ��••
/„� da® ADDRESS Gl��
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS .,yJ//�/Z���j�`�� J.;��TATE
ISTRICT N0.4 GRO/U� K MAP PG PROCESSED BY
CONTRACTOR
ADDRESS ®� ONNECTION DATACITY /� L.NO. STATION - DEPTH 7
REGISTRATION N0. ^ MANHOLE REFERENCE �.�•
�G..9✓��� ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
C,. PUBLIC SEWER @ $3.00 .TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. ( CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
€. EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
t. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.0075
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
a INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE C?® REIMBURSEMENT FEE
I HAVE AT o; TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTS
IINGADWELLIING MED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW // NEW HOUSE SEWER
SIGNED THIS Y 191: L x
t' OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
`. ADDRESS SEPTIC TANK,SEEP.PIT(S) ,
AND/OR DRAINFIELD
1 HERE Y ACKNOWLEDGE THAT I HAV READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ -
�. 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
CALIFORNIA OR THAT THE LEGAL OF THE ABOVE ABANDON HOUSE SEWER
��'•�
DESCRIBED RESIDENT) PERTY. BACKFILL SEPTIC TANKS El
SIGNATURE
SEEP.PIT(S) ❑ CESSPOOLS) ❑ �c P
OF PERMITTE 14
'` ✓
�,
VALIDATIO ROBERT A. WOOD
CK. M.0, CASH SUPERVISING MECHANICAL ENGINEER
t t
Cis' G U L I.1:1j i} 1"y `" t�
5.�_
24650 INSiTS
76AG42D APPLICATION FOR PERMIT
78A642D �®Y
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AB Esse
JOHN A. LAMBIE, Countp Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRoS sT.
LEGAL
DESCRIPTION LOT NO. ...�
BLOCK TRACT
�--
+� / NO.OF BLDGS. rf
SIZE OF LOTJ�, J NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP P CESSED BY
BK j G
CONTRACTOR_ / � /
ADDRESS CONNECTION DATA
a CITY TEL.NO. C� STATION V. DEPTH
STATE REGISTRATION NO. LJ COUNTY MANHOLE REFERENCE UPPER
LOWER
No. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V
@
WORK TO HOUSE SEWER $1.00
SEWEROR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT 03
_ - PERMIT NO. O
INDUSTRIAL U
WASTE APPROVAL W
CHARGES to
OWNER'S PERMIT 2 00 CONNECTION CHARGE FEE FI
' AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEEIHAVE ��_('�
CON-
TRACTORATO THIS
THE ABOVE DESCRIBED EXIISTIINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 AM THE L AL OWNER OF THE OVE _
DESCRIBED RESIDENTI PROPERT BACKFILL SEPTIC TANKS El
SEEP.PIT(S) ❑ CESSPOOLS ❑�'
OF PERMITTEE
OF VALIDATION ROBERT A. WOOD ..
CK.. M.0. CASH / SUPERVISING MECHANICAL. ENGINEER
G
p JJ�1 L-1.t: 2
1 AUG 1 8 3 U (7) 1 L i 9 �n