HomeMy Public PortalAbout5922 MUSCATEL AVE_Sewer__ reaaazo APPLICATION FOR PERMIT 1
:�eoa•a-�a COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER ON;a MOM=
BUILDING AND SAFETY DIVISION BU00ING .`
ADDRESS 1 a d Fl
JOHN A. LAMBIE, County Engineer –
CASSATT D. GRIF'F'IN, Sup°t of Building
—LOCALITY � . yFI '
_�"t=: S'
NEAREST r� /
FOR APPLICANT TO FILL IN CROSS ST
LEGAL c- ^`
DESCRIPTION LOT NO. Ile OWNER � o{i':"� fo f «_ t �<ys,f
BLOCK TRACT fr. FI l
»r— MAIL
LL s .(.F ,h� d`.' - ADD ESS
CITY. t I
', F .% NO.OF BLDGS. '
SIZE OF LOT NOW ON LOT „'�I `��6' TEL.N0. <
USE OF 4
BUILDINGS P u Zf4:A. 4 DISTRICT NO.1 GROUP MAPPROCESSED BY
= BK PG
CONTRACTOR j—/ _ J
ADDRESS : J—COI+NECTION DATA
CITY ,- TEL.NO. STATION DEPTH
STATE
ANHOLE REFERENCE _y UPPER
REGISTRATION NO. COUNTY LOWER
No. DESCRIPTION OF WORK FEE ---- --
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $.3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR x. CURBP.L.XvI,L.TO P.L.
PITS AND/OR_DRAINFI_ELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
E.KTN.,CESSPOOL,DP.YWELL,MANHOLE @ $2.00
HOUSE SEWER. CONNECTING 'PO P.C.NO.
PRIVATE DISPOSAL SYSTEMS @ $9.00 CO,IMP.N0. � _ JOB NO. _
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO. F
_WORK TO HOUSE SEWER $1.00 _
ALTER.REPAIR OR ABANDON HOUSE -STATE ENCROACHMENT
SEWER OP DISPOSAL SYSTEM $1.00 PERMIT N0.
INDUSTRIAL,
WASTE APPROVAL
CHARGES
OMER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION" TOTAL FEE REIMBURSEMENT FEHt
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TO CONNECT THE, ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, —y
~' ti 4' y,. s. NEW HOUSE SEWER
SIGNED THIS _�.. DA°C ®F�„ ]
OWNER OR
CONNECT A-DDITIONAL
OWNERSAGENT i4 rte`' "�' r BUILDING.OR WORK
SEPTIC TANK.SEEP,PITS)
ADDRESS—=-� .Cnfj'•si.. �, .e`r`_ x r,�� r.- ='a �,t.
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND ST'AT'E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWF,LL.(rI
WITH ALL COUNTY ORDINANCES AND STATE LAWS -REGULATING ALTER,REPAIR,SEWER OR:
PLUMBING AND SEWERS, _ SEWAGE DISPOSAL SYSTEM
I HEREBY CERTdFY THAT I AM PROPERLY REGISTERED AND/OR D-ISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I: .AM THE LEGAL OWNER OF THE ABOVE ----
DrSCRIBED RESIDEfYNA�.' PROPERTY BACKFILL
4k:=mak-"Ti CESSPOOLS
SIGNATUREOF PERMITTEE_., _
VALIDATION ROBERT A.WOOD
s�.
X.q. (OMI SUPERVISING MECHANICAL,ENGIII}eKR
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