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Home My Public Portal About9584 KENNERLY ST_Sewer__ -62 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING , JOHN A LAMBIE, County Engineer ADDRESS 3 WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT C- ADDRESS NO OF BLDGS t r^ SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY BK PG CONTRACTOR ' p A ADDRESS rIolf DATA CITY TEL NO STATI - DEPTH 00, TATE MANHOLE REFERENCE UPPER REGISTRATION NO COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGT HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L PUBLIC SEWER @ $5 00 PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO V PITS AND/OR DRAINFIELD @ $1000 HOUSE SEWER CONNECTING TO TRUNK M R D O no PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIv R EA EMENT REC D S R f4OF DATE WORK TO HOUSE SEWER @ $300 (�O OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL ORYWELL MANHOLE @ $5 00 '� ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE '>0CONNECTIO ARGE FEE iHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER ORNEW HOUSE SEWER p OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAITANK SEEP PIT(S) AND/OR AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL P PERTY ABANDON HOUSE SEWER SIGNATURE OF PER MffTEE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M o CASH SUPERVISING MECHANICAL ENGINEER L, .05 5 27.3 t'T,4 3 1 0 D 0~ DEPARTNMVT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER 1 BUILDING �y ADDRESS C/�� V FOR APPLICAKIT TO FILL IN LOCALITY BUILDING NEAREST ADDRESS � �� CROSS ST DISTRICT NO✓ SERIAL NO PERMIT NO. LOCALITY r/ NEAREST r_7,p A 2 3�� S CROSS ST. '_ ,(„� , ,p REGEIVED�BY ' Ready for Inspection DAYE ISSUED L OWNER � 1 Q G�y DDRESS 3(�ez�- � �B�t'�•GG�'i USE ZON OCCUPANCY BK MAP APG CITY ` TEL NO. CONTRACTOR �u• o ' 2 8'/O ADDRESS �. ! �yy a �/I JOB NO �sR CITY ��.Y � TEL NO. �Q,(j �a3lJ , TRUNK PERMIT STATE NO ❑ jREGISTRATION N0. -0-41A [ COt)NdY} ROAD PERMIT NO LEGAL DESCRIPTION LOT NO STATE ENCROACHMENT�,( PERMIT NO BLOCK TRACT ( INDUSTRIAL - WASTE APPROVAL SIZE OF LOT �a/\ /r NOW ON LOTS 1 \ CHARGES USE OF BUILDINGSCONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE `\ REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER (9 $ 350 L �I RECEIPT NO. I DATE I 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 j O 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 2.00STATION ��. DEPTH CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 200 O' el MA UPPE�FERENCE ' j f �W TYPE OF CONNECTION-% LENGTH FROM D OWNERS PERMIT I "� .CURB ( P L� M L TOP L AUTHORIZATION TOTAL FEE Lzw 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.-.-- NEW HOUSE SEWER �,�q a 1^ OWNER OR CONNECT ADDITIONAL BUILDING OR WORK OWNERSAGENT-- ......-------•--•-•--•-------.........._...._.--••-•-- ADDRESS - ...--_--_---.. - SEPTIC TANK,SEEP.PIT(S) ---------- ------•----- ----- AND/ORDRAINFIELD f I HEREBY ACKNOWLEDGE THAT 1 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 I SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 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. 4 BACKFILL SEPTIC TANKS El SIGNATURE- �� - I SEEP.PIT(S)E] CESSP06LS El OF PERM ITTEEW_'. :_:f� - 76A642A 663 7/53 I