HomeMy Public PortalAbout9580 KENNERLY ST_Sewer__ DEPA3tl'MENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY } PERMIT APPLICATION
COUNTY OF LOS ANGELES t
WILLIAM J. FOX, COUNTY ENGINEER BUILDING � �0 �/'�z /z
ADDRESS1-1 x G
FOR APPLICANT TO FILL IN LOCALITY �--�, `
A13 DDRESSG NEAREST
CROSS ST TC.
VLOCALITY -07 DISTRICT NO SERIAL NO. PERMIT NO. c
NEAREST (y �j A S
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CROSS ST r
,,� RECEIV�EiD,�BY�j Ready for Inspection L�DIAT6 ISSUE
OWNER / /'/
ADDRESS 39 �' �,� USE ZONEMAI ? OCCUPANCY BK M P PG /
CITY TEL.NO. / <%( �
CONTRACTOR � . . Z Q
ADDRESS - G(f I`ll�'_Z—1 JOB NO
CITY ?.t��...4. TEL.NO. bpd, G2 �,1� TRUNK PERMIT NO -
REGISTRATION NO //,3 6/3 •C�'T �• ��•COUN'6Y- ROAD PERMIT NO
LEGAL /
DESCRIPTION LOT NO. STATE ENCROACHMENT
(e PERMIT NO
BLOCK TRACT / f INDUSTRIAL
f WASTE APPROVAL.
SIZE OF LOT �� NOW ON LOTNO.OF S CHARGES'-'
USOF
BUE DINGS ,�® CONNECTION CHARGE,FEE "
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE\
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 350 1) RECEIPT NO. �I DATE I BY
HOUSESEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING / N0. I N, 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 / 741_3/, Q' DEPTH �j
CESSPOOL—DRYWELL !
SPECIAL CONDITIONS ONLY 200 �j) / ��l MAyHA .�EFERENCE i(/J
77 fit!/ �U_P_P tf / LB�KF�4'
T PE OF CONNECTION LENGTH FROM
OWNERS
PERMIT g I pp J'� M L TO P L.
AUTHORIZATION TOTAL FEE
IHAVE 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 _____.--_-__--_____ OR WORK
ADDRESS ___ __-_--______ _- - �_ -• _ ---•_ _ --Y_ - _BUILDING^_.�..± SEPTIC TANK,SEEP.PIT(S)
-•---•-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL C]
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 �/� l SEEP.PIT(S)� CESSPOOLS[]
OF PERMITTEE_S�__`-d�_`-_
76A642A 663 7/53-