HomeMy Public PortalAbout9568 KENNERLY ST_Sewer__ DEPARTiVEF,NT OF COUNTY ENGINFXFt
SEWER-SEWAGE DISPOSAL 1.
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENDINEER ( ADDRESS ��6
FOR APPLICANT TO FILL I LOCALITY 7 -
BUILDING NEAREST ���'
ADDRESS CROSS ST
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO
NEAREST .�-.-
CROSS ST
R�E�CEIVED BY � Ready for Inspection DATE ISSUED•[,(
OWNER
R/p ����/i' 1
MAIL USE ZONE`v OCCUPANCY e
ADDRESS a Kate pPG
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CITY
�CL. ,�„p,�T E L.N 0. 10
CONTRACTOR �� �y, , moi aP -7
ADDRESS JOB NO `30(py _3• 1
CITY TEL-NO- TRUNK PERMIT NO
STATE
REGISTRATION NO �� �� &COUlmy ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTZQ NOW ON LOTNO.OFS CHARGE
USE OF
BUILDINGS aQr CONNECTION CHARGE E
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION'RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING /0 I DA BY
_SEWER OR DISPOSAL SYSTEM 1 00 /
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION � O DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 oe QMANJI EFERENCE
..,d PPE i L�(TWER
TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT $ 1 00 " ` Po• M L.TO P.L
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING 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.PIT(S)
---•••--------••-------- ••-- - AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[:] DRYWELL
CA
TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I 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 OR THAT I AM THE LEGAL OWN-
'ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE �A , SEEP.PIT(S)o CESSPOOLS O
�wSI � /►--4sW
OF PERMITTEE_._
76A642A 663 7/53x1 / i