HomeMy Public PortalAbout6218 MUSCATEL AVE_Sewer__ �eA 642D — CE808 — 9/73 'APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONflR...
UILDING �)
DDRESS �L- /v4, (
LOCALITY
EA RE57
FOR APPLICANT TO FILL IN ST.
LEGAL
- eOa1q
OF
SGRIP710N L.07 NO b �/ OWNER
_- MAIL �yL;Jf
BLOCK TRACT ') !� r ADDRESS _
-,
NO.'SOF BLOGS.
SIZE OF LOT I -d NOW ON LOT CITY _ TEL. NO,,
{.,.•
USE OF
BUILDINGS BK PS DISTRICT NO. GROUP MAP ---PR�ESSEO BY
-"i' �'��TJ /
YGONTRACTOR
ADDRESS �"` _ CONNECTION DATA
�-r-
CITY IT TEL. NO. STATION DEPTH
STATE LIC MANHOLE REFERENCE UPPER
LICENSE NO., CLASS LOWER
NO. DESCRIPTION OF WORK T FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $7.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD SIO-00 CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVI4 WM4eR EAE6MEMT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ S3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD _
E XT N.,C E SSPOO L.DRY WE LL. $3.00 CS
HWY.OR ST..WIDENING
A+_�.,REPAIR�0N HOUSE �
SEWER O.RGEA.1.SYSTEM 53.00_ STATE ENCROACHMENT
MANHOLE $7.00 PERMIT NO. .. V
INDUSTRIAL LV
WASTE APPROVAL
HARGES
OWNER'S PERMIT sa
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR`S SIGNATURE
SIGNED THIS. DAY OF 19`. ---'— '--"—"
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS— BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANDJOR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
may`
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR );
LICENSED AS REOUIRED BY LOS AN COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL:FCRNIA OR THAT 1 AM THE LEGAL. OWNER OF, AND ND TO DISCONNECT PLUG AND
RESf DE IN, THE ABOVE DESCRIBED R E IAL PRO RT ABANDON HOUSE SEWER
SIGNATURE_ AC KFIEl
OF SEPTIC TANKS
OF PEi1MTTTEE _- SEEP.PIT(5) ❑ CESSPOOLS
VALIDATION GK.:' M.0. CASH
2 v ' 7I
24650 INSERTS
76A6azD APPLICATION FOR PERMIT
rsas
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
IC)F%N
A. LAMBIE, County Engineer
W%LIIAA3 A. IENSEN, Supt of Building LOCALITY .yr.> ✓�� I
^NEAREST
FOR APPLICANT TO FILA. IN CROSS ST,
LEGAL ,r +}
DESCRIPTION LOT N0. L .;�¢' ' 9 ' OWNER - .
BLOCK TRACT �— MAIL
ADDRESS _
SIZE OF LOTa '. NOW ON LOT 4 CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESS90 BY
BK PCs
CONTRACTOR
ADDRESS . "� CONNECTION DATA
CITY - cg't✓ C.. TEL.NO. / ^ STATION c�� DEPTH
"STATE F- 1^':d vc"' Ei
_RE_G_ISTRATiON N0. -- COUNTY 'MANHOLE RErLR£NCE/J v.. . _LOWER%,, ..
No. DES+ RIPTION OF WORK FEE G
HOUSE ENFR CONNECTING TO
rp
PUBLIC @ $3.00 TYPE OF-C"ai-ir TION /LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CUR ` P.L. M.L.TO P.L.
_ PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
JJI FXTN CESSPOOL, DRY W=LL @ $2.00
MOUSE SEWER CONNECTING TO q P,C.N0.N0,
_ y Y �l JOII
PRIVATE DISPOSE L CO. IMP, NO.SYSTERL @ $i.00 y
cy
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0, ROAD PERMIT NO.°r U..
WORK TO HOUSE SEWER @ $1.00
ALIeR. REPAiRIOR ABANDON HOUSE STATE ENCROACHMENT a
SEWER OR D15PCSAL SYSTEM @ $1.00 PERMIT NO, 0
INDUSTRIAL 8
.WASTE APPROVAL,
CHARGES
OVMER'S PERMIT $ Q2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 4`VREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF 19_.. NEW HOUSE SEWER
OWNER OR r CONNECT ADDITIONAL I
OWNERS AGENT Yi �' _BUILDING OR WORK
ADDRESS---- SE.PTICTANK,SEEP.PIT(S)
—. ---- AND/OR DRA.INFIELO
114EREDY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE 71iAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOLREPAIR,SEW[IDRYWELL D
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ER OR
ALTER,L7£R.
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TH I AM THE LEGAL OW^F"R OF TH ABOVE !
DESCRIBED RESID T AL PROPERTY. ,/ PACKFILL SEPTIC TANKS ❑
SIGNATURE �✓' !' SEEP.PITS) [I CESSPOOLS C1 I _
OF PERMITTEE'+- - 't:ri '
OF "VALII3ATIOIeT ROBERT A. WOOD
,k
cic. M.o. CARR
SUPERVISING MECHANICAL ENGINEER
;