HomeMy Public PortalAbout6152 MUSCATEL AVE_Sewer__ 7SA642D
a E-663 11.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMSfE. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SU -TOF BUILDING '" ".
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. c & OWNER
-A-�J,
M A I L
BLOCK TRACT -,:-q 6".7f ADDRESS
NO OF BLDGS
OF LOT NOW ON LOT CITY TEL. NO.
USE OF I,- - I
A, 3`..
- -t� i
-1L D=1-NI G S DISTRICT No. GROUP. MAP
SK
CONTRACTOR
ADDRESS CbNft�.�T-ION DATA
SIATI0N_ DEPTH
CITY IJ',�
EL. NO,
MANHOLE REFERENCE
STATE. J
REGISTRATION NO. COUNTY
DESCRIPTION OF WORK FEE
T04-HSE TYPE OF CONNECTION LENGTH FR—OM
--
SEWER CONNECTING TO
PUBLIC SEWER Y. CURB- P.L. M.L.TO P.L @
-ou -- - - --
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIFLD $3.00
OVERFLOW SEEPXG7E PIT,DRAINFIELD P. C. N0.
FxT.N..,cESSPOOL.DRYW ELL,M AN HOLE CO, IMP. NO.$2�00 __JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM aril $1.0'0
TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSYEM ca, $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 I 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I PAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S StGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THISDAYOF 9
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
ADDRESS AND/OR DRAINFiELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
OWNERS AGENT SEPTIC TANK,SEEP,PIT(5)
AAND AGREE TO COMPLY ND STATE THAT THE ABOVE 15 CORRECT CESSPOOLO DRYWELL[:1
W1114 ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR __j
DISCONNECT PLUG AND
LICENSED AS
RTQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPNC TANKS Ej
SEEP.PIT(S) Lj CESSPOOLS 0
SIGNATURE /'6 ---
OF PERMITTE Z'L, 4�" ',
E
IO! N A. LAMBIE,COUNTY ENGA4EER `VALIDATION
v ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N.0. CASH