HomeMy Public PortalAbout6266 MUSCATEL AVE_Sewer__ 76A
E-66s rt-=s APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING , f
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS____
CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN
NEAREST
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DESCRA[PTION LOT
BLOCK TRACT ADDRESS
NO.OF BLDGS. .CITY ;._. "' TEL. NO.
- -
SIZE OF LOT_ —_ NOW ON LOT . "- _.USE OF
BUILDINGS _ DISTRICT N0, i GROUP MAP
13K PG
CONTRACTOR
ADDRESS CONNECTION_- - DATA
`— -
_ ---�Y
STATION ' +-'' DEPTH : i-
CITY TEL. NO.
.L _--�-
-- MANHOLE REFERENCE .. - SUPPER
-- STATE
REGIS TR AT ION N0. - tea' ❑ COUNTYNO. ! DESCRIPTION OF WORK FEE _ --- ------- - ---------
-�HOUSE SEWERCONNECTING TO ---- --- TYPE OF CONNECTION LENGTH FROM 1
PUBLIC SEWER __ _—_ @ $_3.50
N _ �._.�""6 Y. : R@+. P.L. M.L.TO P.L. 3.,-------
SEPTIC TAK SE_EPAGE- -PIT OR
PITS AND/CR DRAINFIEL.D. GT $ 9.00
OVERFLOW SEEPAGE PIT DRAINNELD —TI-- t: _ P. C. NO. -
EAIN.,CFSSPOGL,DRYWELL_MANHOLE $2.00
CO. NO..— ._.---JOB NO.
--- -- - - --- --..— --
HOUSE:SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM - r, $1.00 'TRUNK PERMIT' NO, ROAD PERMIT�i0.. _
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Ca., 1.00 I _ PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSE --- - ----- ---------..___--_ —.^___�_
SEWER OR DISPOSAL SYSTEM $I,Op i INDUSTRIAL
------.---.. 1YASTE APPROVAL
CHARGES
._------ —.-._^.- _... CONNECTION CHARGE FEE
OWNER'S PERMIT1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE - "
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I ;
TO THE PUBLIC SEWER. iw _ NEW HOUSE SEWER
SIGNED THIS DAY OF��_ 19 - l
' '�'` � CONNECT ADDITIONAL
: .OWNER OReg BUILD.ING OR WORK
OWNERS AGENT '_- _'4::`- � s.-.�=`i�,.�� . - _
SCPTICTANK SEEP,.PIT(S)
ADDRESS---E �y,G �-'�+. `�--`� � ._ AND/OR DRAINFIELD----, -- ---
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - CESSPOOL El DRYWELL
.AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH 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 DISCONNECT PLUG AND — T
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT ">Alt THE LE"L OWNER. OF THE ABOVE — —
DESCRIBED RESIDENTI PROPERTY. A BACKFILLZ.'T ,.. ^'Y- ,, {' � M1
SIGNATURE
OF PERMITTEE.
IOHN A. L.ANIBIE..,-OUNTY ENGINEER ,VALIDATION ROBERT A.WOOD,CHIEF PLHG. INSPECTOR
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B. CASH - -
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