HomeMy Public PortalAbout9583 KENNERLY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER
SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FQZ APPLICA T O FILL IN LOCALITY C,
BUILDING NEAREST
ADDRESS CROSSST
LOCALITY G DISTRICT NO. SERIAL NO. PERMIT NO.
_ c
NEAREST A 23��� S
CROSS S
' GRECSE ,BY Ready for Inspection DAT ISSUES
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OWNER � I �� G
MAIL n o USE ZON�� OCCUPANCY / MAP T
ADDRESS
EK PG
CITY TEL.NO. /7 �lI
CONTRACTOR �^ �. Qj -,-,0 �,—
ADDRESS /. �,� � �1 JOB NO C �s�6
CITY'
rw6 TEL.NO � A �� TRUNK PER/MIT NO
STATE
REGISTRATION NO ' 491 3 ' (1PA B-COUNTY, ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO
BLOCK TRACT /, ` INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO OF S X /20NOW ON LOTS CHARGES
USE OF
BUILDINGS - CONNECTION CHARGE EE
NO. DESCRIPTION OF WORK FEE F REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO U
PUBLICSEWER @ $ 3.50 (� RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO ,
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR XXCEPTION ECORDED
WORK TO HOUSE SEWER 1 00 1
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 / '� . O DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 MA=ERENCE�
UP ER L�OAWER
_ TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT f 1 00 P'L 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-_-..._....-_..____----_- 19-._.. NEW HOUSE SEWER 5 �-Ce 4-,?/
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----- _ _ BUILDING OR WORK
ADDRESS . _------__ ._. ________ SEPTIC TANK,SEEP.PIT(S)
-.
- - ••-•• AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS-REQUIRED BY LOS ANGELES COUNTY AND
DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS I]
SIGNATURE �� �f- - -
OF PERM ITTEE...L�G___ ' !!"' _t'! `_ -
76A642A 663 7/53 oo e,