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HomeMy Public PortalAbout6112 MUSCATEL AVE_Sewer__ E808 8.sa APPLICATION. FOR PERMIT eeoa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FAUILDING , DDRESSIOHN A. LAMBIE. Count. sneer CASSATT D. GRIFFIN. Supt of Building OCALITYEAREST F`OR APPLICANT TO FILL IN RDss ST. ,-r; LEGAL DESCRIPTION LOT NO. _ � OWNER y { BLOCK - MAIL TRACT s— ' ADDRESSrjvl NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL, NO. USE OF BUILDINGS lx DISTRICT NO. GROUP MAP PROCESSED BY CONTRACTOR BK PG ADDRESS . �' CONNECTION DATK CITY y TEL.NO. t` STATION O• t'f x DEPTH l REGISTRATION NO. y STATE MANHOLE REFERENCE J , e UPPER f Q COUNTY } ' NO. DESCRIPTION OF WORK FEE - HOUSE SEWER CONNECTING TO ^s PUBLIC SEWER @ $3.00 TYPE OF,C47"ECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. GURB.f P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN..CESSPOOL.DRYWELL $2.00 HOUSE SEWER CONNECTING TO P,C.NO. - PRIVATE DISPOSAL SYSTEM @ S1.00 _CO.IMP. NO. 4', JOB NO. CONNECT ADDITIONAL BLDG.OR R @ $1.00 0. WORK TO HOUSE SEWER TRUNK PERMIT N0. ROAD PERMIT N .* SEWER'OTERR DA'PO AABYSTEM HOUSE @ $'06 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 Q0 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE I I REIMBURSEMENT FEE I HAVE AT'THIS DATE A CONTRAC WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE A IYESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNEDCEZ Ot 19_ NEW HOUSE SEWER OWN OWN£FRS &&&..."'...::"'J .: ... r''l CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE RFf6 THi APPLICATION AND STATE THAT THE ABOVE IS CORRECT a'N© A E 70 COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STAIIE..- WS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR _ [ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE T£ OFF ABANDON HOUSE SEWER CALIFORNIA THAT I AM THE LEGAL NER OF THEABOVE or.e. see ii;s DESCRIB,E.D RESIDENTIAL PRRTY. BACKF'LL 5�-1?:•r,,.'z4 s CESSPOOLS f:' OF �• VALIDATION ROBERT A. WOOD CK. M.0. "Sit SUPERVISING MECHANICAL ENGINEER `