HomeMy Public PortalAbout9581 KENNERLY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWED—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY ! PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
� ADDRESS
FOR APPLICA T TO FILL IN LOCALITYBU'LD IN G NEAREST
ADDRESS ef/9li) CROSSST rl�P L v
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A% J
CROSS ST
RECEIVED BY Ready for Inspection DOE ISSI�D
OWNER y�/,$ /i6y/f J
MAIL USE ZONE OCCUPANCY BK AP PG
ADDRESS r ;
CITY P TEL.NO. ��C �
CONTRACTOR e= .� t�Zl (J)�f u�.sGl.)Q, h C_. Z Q I6
ADDRESS /�- y �.. �J��lee� / JOB NO
CITY TEL.NO. Ob/� ,th�� ��' TRUNK PERMIT NO
STATE
REGISTRATION NO. j /.J • �� �'�2 B-COUNTY ROAD PERMIT NO
LEGAL r // ; STATE ENCROACHMENT
DESCRIPTION LOT NO. / PERMIT NO
BLOCK TRACT / �b WASTE APPROVAL
SIZE OF LOT,,,SSx J 20 MO_OF NOW ON LOTS CHARG
BUILDINGS USE CONNECTION CHAR E FEE
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NO. DESCRIPTION OF WORK FEE
/ REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 RECEIPT NO. DATE BY
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 I DATE BY
_SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 J CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 200 / MANHPO E� EFERENCE
TYPE OF CONNECTIO LENGTH FROM '
OWNERS PERMIT ; 1 00 '_&U49' CE—L--) M L.TO P.L
AUTHORIZATION TOTAL FEE b
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDII
CONTRACTOR
NG TO CONNECT TSHE EWEROVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLSIGNED THIS-------------------DAY OF--------------------_.____ 19_____ NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL OWNERS AGENT.-------••--•---•-----........---•-----------•-----...._--....._, BUILDING OR WORK
ADDRESS t SEPTIC TANK,SEEP.PIT(S)
- - .. _ -_ _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL E �—
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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
n j
SIGNATURE SEEP PIT(S)E] CESSPOOLS``�� � - - -� >C, ,-
j OF PERMITTEESX___:_
W76AG42A 663 7/53 O sa
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