HomeMy Public PortalAbout6015 MUSCATEL AVE_Sewer__ lDEPARTMENT OF COUNTY ENGLNEER SEWER-SEWAGE DISPOSAL
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VISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING , ? K, f NEAREST
ADDRESS [G /L �ffSL� "i CROSS ST.
LOCALITY Gf vv �, 1 'u jr DISTRICT NO, SERIAL NO. PERMIT NO. C
NEAREST J
CROSS ST. lu, FFF ----
F 9F RECEIVED BY Ready for Inspection DATE ISSUED
OWNER � y
MAIL ADBRESS&&j �g ,:,�, USE ZONE OCCUPANCY BK MAP PG
✓dr �IL�J
CITY tom.— +. TEL.NO.
CONTRACTOR r� �,✓s GO.IMP.NO.
ADDRESS �1 !jam
JOB.NO.
CITY TEL.NO. (F ✓
TRUNK PERMIT NO.
[,
REGISTRATION NO. STATE
-6r E) COUNTY ROAD PERMIT NO,
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT NO. L _PERMIT N0,
BLOCK TRACT �� L' INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF NOW ON LOTS CHARGES
USE OF
BUILDINGS 4 ")�„ CONNECTION CHARGE FEE
NO. DESCWIFITION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO -
PUBLICSEWER 0 $ 3.50 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 i
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I e MANHOLE REFERENCE-
I TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ { I 00 �" cuRs= P_ M.L.TO P.L.
AUTHORIZATION TOTAL FEE t
CONTRACTOIR TO CONNECT THE ABOVE DESCRIBED ATE CONTRACTED WITH THE I EXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TIJE PUBLIC SEWR,
SIGNED THI . DAY OF I9 NEW HOUSE SEWER `
_- __. _
OWNER OR CONNECT ADDITIONAL
OWNERS AGE T. [I` .:_- �� — BUILDING OR WORK
: r I- SEPTIC TANK,SEEP.PIT(S) I
ADDRESSC.c[--JEs }rtrXJ.LEVIrf:(e.t .. £"`.� - AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ iS 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. 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 I AM THE LEGAL OWN-
ER OF THE ASOV DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE. --- ----- - -..-. --------•---. ------
76AW42A 663 7/51