HomeMy Public PortalAbout6025 MUSCATEL AVE_Sewer__ GE806 11-87 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY-DIVISION BUILDING —
JOHN A. LAMBIE. County Engineer _ADDRESS
CASSATT D. GRIFFIN, Supt of Building
LOCALITY
Mi NEAREST
FOR APPLICANT TO FILL IN CROSS ST. _� _
LEGAL — - -
DESCRIPTION LOT NO. OWNER
BLOCK. TRACT ! MAIL
.� ADDRESS
NO.OFBLDGS.
SIZE OF LO _ NOW ON LOT CITY TEL.H0.
USE
BUI4DINGS� a DISTRICT N01 GROUP MAP
CONTRACTOR J Y� BY. PGr
Ai
ADDRESS )', �, ,, � CONNECTION DATA
CITY TEL.NO. < n' STATION J > DEPTH fir.
STATE 14ANHOLE REFERENCE �
REGISTRATION NG', COUNTY .�' "; '� f"3�`�.. LOWER",
No. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO r+.y, e+''
PUBLIC SEWER_ @+ $3. r:
SEPTIC TANK,SEEPAGE PIT OR TYPE .E.PTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 _ .-, Y. CURS;!' P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
_EXTN.,CESSPOOL,DRYWELL,MAN.40LE @ $2.00
HOUSE SEWER CONNECTING TO O.
P.C.N
_PRIVATE DISPOSAL SYSTEM @ $1.00 t'0.IMP.NO,ii' JOB N
CONNECT ADDITIONAL BLDG.OR �, T,__ ,l
WORK TO HOUSE SEWER @ $5.00_ TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
.s. a PERMIT NO,
�- •�-`--' :, 1 -INDUSTRIAL.
ay r. WASTE APPROVAL
CHARGES
MAWS,)"S,)" _PER . J CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAE AT THIS DATE A CONTRACT WITH T14ETRACTOR TO CONNECT THE ABOVE DESCRIBED EXIISTIINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. - -
SIGNED 7HiS__ DAY aF z7" 19
_NEW IlousE sEwER
OWNER OR t CONNECT ADDITIONAL
OWNERS AGENT '�'r°ry yo-�- �--t�4E r � _BUILDING OR WORK
ADDRESS";•.< z., / •�I`� SEPTIC TANK,SEEP,PIT S?
: "�` -..� •� a.`� ~.a ":�'
AND/OR DRAINFIELD
IH
ACKNOWLEDGE THAT I HAVE READ THIS APP CATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING --
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
-,CF,NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF' DISCONNECT PLUG AND -
CALIFO IN IA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIB;D ?�SIDENTIAL PROPERTY. BACKFILL S
SIGNATURE _S`-4* -j'�CESSPOOLS [L'1-
OF PERMITTEE._._,
�a
—,--VALIDATION ROE3ERT A: WOOD
- ✓ C/sr�" M.o. CASH SUPERVISING MECHANICAL..ENGINEER
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