HomeMy Public PortalAbout6008 MUSCATEL AVE_Sewer__ 7GA642D
'ffi$t E-6633 3_E53 APPLICATION FOR PERMIT
7
DIVISION OF BUILDING AND SAFETY SEWER-oSEWAGEDISPOSAL i■A
Department of County Engineer
County of Los Angeles aoltalt�a _
WM.J, FOX. COUNTY ENGINEER _ADDRESS e � J fi
CASSATT 0.GRIFFIN,'SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESTy o Y
CROS5 ST. .>,_ ,;"`•U' ,F _
LEGAL -
DESCRIPTION LOT NO OWNER
BLOCK TRACT :`- <-. r` I
-ADDRESS MAIL
!`. +G .( .z,.:
r _/�fOW ON LOT CITY 0. OF BLDGS,
OF LOT
SIZE k _
— � TEL. NO.
USE OF
DISTRICT NO. j CROUP ( MAA
SK PG
CONTRACTOR-',,
ADDRESS ' .: - — _C®1Rii�]'ECTIOY DATA
.
—
_CITY-__ TEL, N0. - '�� n STATION_ _ -_ DEPTH
�✓ STATE MANHOLE REFERENCE _^UPPER
REGISTRATION N0. ''- ,F - COUNTY
NO. I DESCRIPTION OF WORK FEE _-__ -_.---- -- --.- —
HOUSE SEWER CONNECTINC To - TYPE CSI'CONNECTION LENGT H FROld:fl Y�
-PUBLIC SEXER_- --- a, $ 3 _Y. CURB __--- Y.L_— M 1._TO,P P.L.
-.--
_ _!✓ _.50 i � ___. _ _ `
I HOUSE SE4t ER CONrV ECTTNG 1'D
PRIVATE DISPOSAL SYSTEM 1.04 (-_- -- ----- ----..- —
I CCN NECT ALDITYOAtaL BLDG. OR - P. C. NO.
'AORK TO HOUSE SEWER 1.0_0_ ( -- CO. IMP. d0. JOB NO.
I ALTEk.OR REPAIR c,tiSTfNG i?l'NK PERMIT N0, ROAD PEAtdIT N0.
SEYiE_ 7
R OR DISPOSAL SYSTEM 1.00 _- �`- `
DISCONNECT AND ABANDONSEWER __-- _STATE ENCROACHMENT
AISD'DR
DISPOSAL SY TF',7 1T00 - I PERMIT NO.
SEPTI' TAND/OPY SMITES PIT ORPI' - 0 ja INDUSTRIAL
I CE POOL-F YWEL tELD 2.Q0 J WASTE APPROVAL
CrnaP00L DRY4vELL
_
SPECIAL CONDITIONS ONLY 2.00 -_. CHARGES
'-- ---'- CONNECTION CHARCtE FEE.
AUTHORIZATION
�g��+OWNE�R`Sp �pT PERMIT $t--111 Oo --. _— -.__---- -------------�.._
AUT It7FcI A 11V TOTAL IEE � - REIMBURSEMENT FEE ---�
1
I HAVE THIS DATE CONTRACTED WITH THE HEREIN Nr1MED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXiSCiNC DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO 7H7PUBLIC SEWER a - '-_-"�-- ---` --
,r: /,; d NEW HOUSE SEWER '-�--
SIGNED THIS_- . DAY OF ,° > s 19
OWN ER OR CONNECT ADDITIONAL
OWNFRS AGEN '� 5''' i,„ �' .,_2 ._ �� •'=� -BUILDING OR WORK
'� SEPTIC TANK,SEaP PIT(5)
ADDRESS Atv D/OAuPkffl iELD _
I Ht:RE@Y ACKNOWLEDGE THAT 1 NAVE READTH TCATIONf CESSPOOL.Fj DRYWELLLD�
AND STATE THAT THE ADOVE IS CORRECT AND AGREE TO C6MFLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER REPAIR,
DISPOSALSYSTEM REFAiR, SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REG' TERED AND/OR SEWAG'----- POSAL--'
LICENSED AS REQUIRED BY LOS .ANGELS CDU AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AMTHE LEGA OW R OF THE A�OVE ABANDON HOUSE SEWER
DESCRIBED F.ESIDE.N AL PROPERTY. .' a BACKFILL SL C
SE:"' It,�.::sj CESSPOOLS F] I
SIGNATUREOF PERMITI'rr;)' - � .a 'd ., A., C� ft
WILLIAM J.FOX,Co' TY ENGINEER r ATION R.A.WOOt3. CHIEF PLBG. INSPECTOR