HomeMy Public PortalAbout6154 MUSCATEL AVE_Sewer__ '°A 8 8 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BnnR ss
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of building LOCALITY
NEAREST
FOR AP LICANT TO FILL IN CROSS ST.
LEGAL f;
DESCRIPTION LOT N0. , OWNER d__ _ ✓- ° �' .�MAIL
_ t
BLOCK TRACT ADDRESS
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NO.OF 5LDGS. f
SIZE OF LOT°, tan - , -e N W ON LOT CITY •" NO14
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USE OF �V AISTRICT N0; GROUP MAP PROCESSED BY
BUILDINGS 4 BK PG
CONTRACTOR
,.---- CONNECTION DATA -
CITY TEL.N0.j, STATION ;• ��( F DEPTH s
STATEMANHOLE REFERENCE _ k �`i- '.t}fPER.��..
REGISTRATION NO. "- COUNTY f4, LOWER
NO. I DESCRIPTION OF WORK _ FEE
HOUSE SEWER CONNECTING TO .< _ -
PUBLIC SEWER @ $ .00 !} L. TYPE OF CONFECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. ?CURB P.L. M.L.TO P,L.
PITS AND/OR DRA€NFIELD @ $1I.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EX
TN . CESSPOOL,DRYWELL @ $ .00
HOUSE SEWER CONNECTING TOP.C.N0.
.PRIVATE DISPOSAL SYSTEM @ $.00 CO.IMP. N0. ,:F ^-'I JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. ✓ r"T
WORK TO.HOUSE SEWER @ $ .00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISP65A.L SYSTEtd @ $ .00 --PERMIT NO.
t INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 312 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I e e "I REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTIINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS_ __nAY OF � F ]9 `` NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT 4' *' BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRE4 B/ LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN% PROPERTY. ,� BACKFILL SEPTIC TANKS ❑ -
*
SPGNATUSEEP,PIT(S C] CESSPOOLS
-
RE .
OF PERMITTEE �"`
f' VALIDATION.=' ROBERT A. WOOD
CL M.G. N.' SUPERVISING MECHANICAL ENGINEER