HomeMy Public PortalAbout9560 KENNERLY ST_Sewer__ TEMPLE CIT`
7eA842D APPLICATION FOR PER-MIT
ceeoe a-ea COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �o �
ADDRESS
JOHN A. LAMBIE. Count Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY J
FOR APPLICANT TO FILL IN NEAREST
,,>> r CROSS ST i[st
AL
DESCRIPTION LOT NO T G .S- aZ OWNER
BLOCK TRACTy , MAIL B
.7 8 ADDRESS _
NO OFBLDGS f
SIZE OF LOT NOW ON LOT CI EL NO A6—Z7 7Z
USE OF DISTRICT NO GROUP MAP PROCE D BY
BUILDINGS I BK PG I
CONTR TOR
ADDRESS CONNECTION DATA �V
CITY E STATION
DEPTH
STATE __0
REGISTRATION NO B COUNTY MANHOLE REFERENCE /' ' ,/ UPPER
No I DESCRIPTION OF WORK FE ) L/
HOUSE SEWER CONNECTING TO
PUBLIC SEWER C. $ Oo TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y CURB P L M L TOP.).
PITS AND/OR DRAINFIELD @ $100
OVERFLOW SEEPAGE PIT,DRAINFIELD Ja✓�L'`Cs
EXTN CESSPOOL DRYWELL @ $100
HOUSE SEWER CONNECTING TO P NO.
PRIVATE DISPOSAL SYSTEM @ $100 moo' OB N0.
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT N0. ROAD PERMIT NO
WORK TO HOUSE SEWER @ S100
ALTER REPAIR
DIIRO R ABYSTEM HOUSE @ OO STATE ENCROACHMENT
PERMIT NO
h INDUSTRIAL
WASTE APPROVAL
CHARGES
O 'S PERMIT S 2 00 NECTION CHARGE FEE
AUTHORIZATION TOTAL FEE EIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEREINED CON- -
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGADWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER ��
OWNER CONNECT ADDITIONAL
A
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP PIT(S) t
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [:1 DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT I PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE l ^� ,i SEEP PIT(S) E] CESSPOOLS
OF PERMITTEE '�
OF VAMATION-----� ROBERT A WOOD
CIL X.0, cAsB SUPERVISING MECHANICAL ENGINEER
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