HomeMy Public PortalAbout6118 MUSCATEL AVE_Sewer__ r6A ,663 IT-55EAPPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY - -- -_---
FOR APPLICANT TO FILL IN NEAREST.
LEGAL g
DESCRIPTION LOT NO �,�X �. ""� 3 I. OWNER
BLOCK TRACT �+' (,t°. t'-' MAIL
ADDRESS
NO. OF dLDGS. .,- CITY' TE... NO.
SIZE OF LOTNOW ON LOTUSE OF
-
BUILDINGS DISTRICT N.O. GRUUP MAP
BK PG
CONTRACTOR
CONNE TION DATA �—
ADDRESS t..., 1F,`; --_... - --------
STATION -• _ DEPTH
CITY TEL NO --
-- --- -- MANHOLE REFERENCE _UPPER
-..... " -- .Q STATE — _ ��� :.�x'd c•...,� �_ ..
REGISTRATION N)!: .i[,, [] COUNTY
NO.! DESCRIPTION OF WORK —FEE TYPE OFCCT3.ON LENGTH FROM
HOUSES EWER CONNECTING 70 ---- -� y• URB P.L. M.L. TO P,L.
—. PUBLIC SEWER
SEPTIC TANK,SEEPAGE PIT OR �`_-
�j PITS ANO/OR DRAIN_FIELC - �� 3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD -T-- -r P. C. NO.
f-•X1N.,CESSPOOL,DRYYvELL,M'ANHOLE n $:2.OQ CO. IMP NO, '`'3 - JOB NO.
HOUSE SEWER CONNECTING TO _ :-,
PRIVATE DISPOSAL SYSTEM ( $1,00 TRUNK PERMIT NO ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
-I WORK TO HOUS£-SEWER — - _ ("z $_1.00 I _ I PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - I-- -- _-_ ---------------- -----
I SEWER OR DISPOSAL SYSTEM (a $1.00 I WASTE APP
-- _,-!.- - - -- -. _ WASTE APPROVAL
l _
CHARGES
---------- _ -- -_—.- �_ CONNECTION CHARGE FEE OWNER'S PERMIT PERMIT $ t Do — ---- ----A--
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAI EU CON- _ APPROVALS I_DATE_--'INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, - NEW HOUSE SEWER
SIGNED THIS _SDA_ OF .�9----- CONNECT ADDITIONAL
OWNER UR ' �" BUILDIN OR WORK
OWNERS ACENT�'. z' s'- '�' �fi" --- _. --- ----- ----�-" - - --. ..--- ----
'�j SEPTIC TANK,SEEP,PIT(S1
ADDRESS .�� ''•l;:,��. __✓>l ---�� b"... � s -�-,�`- AND/OR DRAINFIELD
l HEREBY ACKNOWLEDGE THAT I HAVE REAL) THIS APPLICATION CESSPOOL r 1 DRYWELL O
AND .STATE THAT THE ABOVE IS CORRECT A14D AGREE TO COMPLY —..— _.._— __ `
...... 1_ 1 -.—
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR �_.._�,.
PLUMBING AND SEWERS. SEWAGE.DISPOSAL_SYSTEM
I HEREBY CERTIFY THAT I .A M3 PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LF,GAL OWNER OF THE ABOVE --- ---- ---+- - -
DESCRIBED RL"SIDENTIAL PROPERTY 6ACKFILL SEPTIC TANKS[J
' SEEP.PIT LS) D CESSPOOLS L-: i
SIGNATURE . ' --..-. ._----------`—�-
OF PERM ITTEF
70HN A. LAMBIE,COUNTY ENGINEER VALIDATION-— ROBERT A. WOOD,CHIEF PL®G. INSPECTOR
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