HomeMy Public PortalAbout6132 MUSCATEL AVE_Sewer__ 8&E•663 12•54 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY' SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. PDX. COUNTY ENGINEER ADDRESS
CASSATT-D.GRIFFIN.SUP'T OF BUILDING 1-1
-OCALITY � _._. 'z_f
FOR APPLICANT TO FILL IN 14EARESr
CROSS ST.
LEGAL —
DESCRIPTION LOT NO 1- OWNER
BLOCK TRACT MAIL
ADDRESS
N0, OF ELDGS,
—
SIZE OF LOT -- NO_J ON LOT CITY TEL. N0,
USE OF
BUILDINGS MAP DISTRICT NO. GROUP
BK PG
_
CONTRACTOR T
ADDRESS CONNECTION DATA
CITY - 7EI_. N0, STATION �` � DEPTH k
E2 STATE - g MANHOLE REFERENCE If
p T ar'
REGISTRATION N0. ❑ COUNTY .g -� � �y'��`'.�����._k. ) .F_• OPER
TYPE C>�+,�-C,NNECTION l LENGTH FROM y �. ---
N0. DESCRIPTION OF WOR.Ii. PEE _— �CL'tt__y P.
M.L.70 PAL.
�i NOUSE SEh'ER CONNECTING TO .
I PUBLIC SEWER_ (TI $ 3:50
�i HOUSE SEVERCO.NNECTfNG TO 4
P4jVA71= DISPOSAL SYSTEM _Y.-00 h_ -
CONNECT ADDITIONAL BLDG, OR CO, IMP.NO F m p JOB. N0.
WORK.TO HOUSE SEWER_ I.00 _-_.. _ x
AL FR OR RFPAIR EX1 TIN:, - sss -fi--`p*'4
SEWER OR DISPOSAL SYSTEM_ _ i.00 I TRUNK PERMIT NO. ROAD PERMIT
"...^
DISCONNECT AND ARAN-DON SEWER
_ AND10R DISPOSAL 3_YSTEMSTATE ENCROACHMENT_ _ 1.00 � I ---_, PERMIT NO.
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAIMFIELD G 00 i { iNDUSTtRIAL
CESSPOOL-URYWELL WASTE APPROVAL
_I SPECIAL CONDITIONS ONLY 2.00 _ CHARGES
—'--- -'------ _—i,— __I _ — - -------'--
PEIZ,NYFT ;— CONNECTION CHARGE FEE
ER'
OWN $ _ S 1 ' 00
AUTHORMATION TOTAL FEE i ' REIMBURSEMENT FEE
I HAV' THIS DATE CONTRACTED 'WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING D`A'ELLING. APPROVALS DATE INSPECTOR'S SliNATURE.
TO THE PUBLIC SEWERNEW HOUSE SEWER
SIGNED THiS_ _—DAY
OWNER OR CONNECT ADDITIONAL
_ BJILDING OR 1!'ORK
OWNERS -
A"DDRESd_____.� _SEPTIC TANK,SEEP, PIT(S)
—p_--- -.-
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El DRYWELL C7
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ .....�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AMPROPERLY REGISTERED AND/OR _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER *OF THE ABOVE _rBA.NDONHOUSESEVtER _
DESCRIBED RESIDENTiAL PROPERTY. BACKFILL SEPTIC TANKS 0
SEEP.PIT(S) 0 CESSPOOLS 0
SIGNATURE. —� — - — -
OF PERMITTEE
WILLIAM.FciFQX.6Au1ITY ENGINA&R VALIDATION
"7 ri I �k 4,.
BY BY
DEPUTY DEPUTY
BY BY a"t-
�#1 DEPUTY DEPUTY