HomeMy Public PortalAbout9571 KENNERLY ST_Sewer__ i
DEPARTMENT OF COUNTY ENGINEER, ' SEWERt -SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS ��7LV
FOR APPLICANT TO FILL IN LOCALITY ^� r
BUILDING ` NEAREST
ADDRESS j CROSSST
LOCALITY ; DISTRICT NO. SERIAL NO PERMIT NO c
NEAREST 23 x'97 S
CROSS ST ' RECEIVED BReady for Inspection �DATE ISSUED
OWNER cI`1// /A!;-//
MAIL USE ZONEOCCUPANCY MAPADDRESS 3BK
PG
CITY + TEL NO. I
CONTRACTOR C�, 1yd
COakM E�NOs
ADDRESS /" JOB NO
CITY �( / TEL NO.,0d, �'�)3� TRUNK PERMIT NO
STATE
REGISTRATION NO.
/1 4=► T2 ®:000NXX ROAD PERMIT NO
LEGAL J /�
DESCRIPTION LOT NO STATE ENCROACHMENT
L CJ / PERMIT NO
BLOCK TRACT ,�/6 WASTE APPROVAL
SIZE OF LOTNO OF
NOW ON LOTS CHAR S
USE
—BUILDINGS CONNECTION CH GE FEE
(,���,.
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT F
HOUSE SEWER CONNECTING TO �/,i
PUBLICSEWER @ $ 3.50 (J 67 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR / EXCEP .10N RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING / NO I DATE I 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 (0 -1-73,62 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200MANHOLE EFERENCE LOWER
L+ �J
TYPE OF CONNECTION LENGTH FROM ��—
OWNERS PERMIT $ I 00 P L.) M.L. P.L.
AUTHORIZATION TOTAL FEE �d {
I 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.-.__s NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT---------------_......-.......... __. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. - - - - - - AND/OR DRAINFIELD
I 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❑
SIGNATURE ^ /�jf (��,y SEEP.PIT(S)� CESSPOOLSEl
OF PERMITTEE--(Y..L29?! 5--4.!W!_--_'�+.= --
76A642A 663 7/53 r �-