HomeMy Public PortalAbout9570 KENNERLY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
13U1LDING
WILLIAM J. FOX, COUNTY ENGINEER
FOR APPLICXT
TO FILL N ILOCALITYBUILDING NEARESTADDRESS CROSS ST
LOCALITY t, DISTRICT N0. A SERIAL NO PERMIT NO. C
NEAREST b' �J (/ —� � 13efVJ
CROSS ST. 1J , REC E ,gy ' Ready for Inspection ,DATE/ISSUED /
OWNER c ' 1 3
MAIL USE ZOO OCCUPANCY MAP
ADDRESS � �
BK PG
CITY TEL NO.
CONTRACTOR " �' `AQ, //\�/
ADDRESS L�'LU� �w-r JOB NO L76,? y V
CITY � .,..TEL.NO. Gl([, TRUNK PERMIT NO
TAT
REGISTRATION NO �/ 6�3�' m T � ®..COId'A1U ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 7 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
�^y 9f NO OF BLDGS.
SIZE OF LOT
SJ X_42,0 NOW ON,LOT CHARGE
USE OF
BUILDINGS � �9�te CONNECTION CHARGE F€E
NO. DESCRIPTION OF WORK FEE a'
HOUSE SEWER CONNECTING TO — � REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 V-rl RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO* DATE `�BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AHD/OR DISPOSAL SYSTEM 1 00 - CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 071- 77 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 �� MANHOLE REFERENCE
ellRft LOWER
r, TYPE OF CONNECTION LENGTH LENGTH FROM
OWNERS PERMIT ; I pp i� °�w PL , M.L.TO P L
AUTHORIZATION I 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_------_------------- ----_---- 19NEW HOUSE SEWER S a 6-C, >¢
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_____________ _________ BUILDING OR WORK
ADDRESS_. __ .- SEPTIC TANK,SEEP.PIT(S)
-- - - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CATION AND 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
SIGNATURESEEP.PIT(S)� CESSPOOLS
OF PERMITTEE_� _A .._...._ !_. _ '
76A642A 663 7/53 '7.1