HomeMy Public PortalAbout6122 MUSCATEL AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
fOR APPLICANT TO FILL IN LOCALITY
BUILDING R � a �� ®t+c e / NEAREST
ADDRESS /�f �JJ �j ROSS ST.
LOCALITY e4OY DISTRICT NO. SERIAL N0. PERMIT N0.
NEARESTA S
CROSS ST.
RECEIVED BY Ready for Inspection DATE{SSU ED
OWNER
MAIL /
USE ZONE OCCUPANCY BK MAP PG
CITYZL
CONTRACTOR1'" L
' - ar ! �' " CO.IMP.N0.
ADDRESS s j I �e
nom-- JOB.N0.
CITY TELAO.
67i- t _ TRUNK PERMIT NO.
R f
REGISTRATION NO. 1 ? C UNTY ROAD PERMIT NO.
LEGAL r
DESCRIPTION LOT NO&q.
STATE ENC NOROACHMENT
BLOCK TRACTi INDUSTRIAL
�- WASTE APPROVAL
SIZE OF LOT " NO.OF BLDGS. "
+� NOW ON LOT a/� CHARGES
USE OF 10
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER_ 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- DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 I -
DISCONNECT
DISPOSAL ABANDON SEWER
SYSTEM
AND OR1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_
PITS A_ND/ORDRAINFIELD 2.00 I _ STATION DEPTH
(CESSPOOL—DRYWELL +
I SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
4 - UPPER LOWER
I TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 00_
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER _
SIGNED THIS_....Q.......DAY O. .- � '� ....Ig'� NEW HOUSE SEWER
OWNEROR YA CONNECT ADDITIONAL
OWNERS AGEW BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS------ f11.�.=---=- a.'!a AND/ORDRAINF{ELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 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
IHEREBY CERTIFY THAT 1 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 ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E] �—
x e SEEP.PIT(S)o CESSPOOLS E] i
SIGNATURE 4, ;, VeOFPERMITTEEI_- .1' ..-._. , •---- -------_---..
7GA642D 663 1/53 `If