HomeMy Public PortalAbout5722 MUSCATEL AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS i SE 0508 1312030008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: ISEWER / SEPTIC: SEWER I BUILDING ADDRESS: I
ITR: 3623 IT: 122 (EXIST OCC GRP: 1 5722 MUSCATEL AV N
_IBLDGS. NOW ON LOT: I SGAB CA 917753011 1
[ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET: LAS TUNAS
15387-011-026 (ORIGINATION: I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI
ILENGTH ML TO PL: STATION: PC' DEPTH: 1 I
(TENANT: ]MANHOLE REFERENCE: UPPER/LOWEIb?T `t (ISSUED ON: PROCESSED BY: I
I 112/03/13 SR
I I
1 COUNTY IMPROVEMENT NUMBER:
(OWNER: TEL. NO: IPLAN CHECK NUMBER: 1 IN D INAL BY: CODE: 1
1WHITTINGTON, MATT H (626) 377-7448- JOB NUMBER: 1 [
15722 MUSCATEL AV (TRUNK PERMIT NUMBER: 1 I
ISGAB 917753011 ROAD PERMIT NUMBER: ID PT 0 OF WORK 1
1 1AFFADAVIT: NO ISEWSR LINE REPLACEMENT 1
I IWAIVER: NO 1 f I
(APPLICANT: TEL. NO: )I EASEMENT: NO 1 I
ISAME AS OWNER
1 RECORD INSTRUMENT NBR: RECORD DATE: 1
�[ 1SPECIAL CONDITIONS:
1
I(HIGHWAY/STREET WIDENING: ` 1
I STATE ENCROACHMENT PERMIT NUMBER: I `p\� \I �� yr! 1
ICONTRACTOR: TEL. NO: I FEES PAID 1APP$OVALSvv \\ ATE INSPECTOR SIGNATURE 1
ISAME AS OWNER - _II
ILIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER I [ [
I 101 PERMIT ISSUANCE FEE 27.80 (CONNECT ADDITIONAL I I I
I 115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 1BUI:AING OR WORK [ I I
(ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.30 1 I [ I
I - ''I ISEPTIC TANK, SEEPAGE PITI I I
LIC. NO: (AND/OR DRAIN FIELD
1 1DRYWELL
SEWER MAP BOOK: PAGE: 1ALTER, REPAIR, SEWER OR I I I
1SEW7 GE DISPOSAL SYSTEM [ I I
(DISCONNECT PLUG AND 1 I I
IABANDON HOUSE SEWER 1 I I
I (BACKFILL SEPTIC TANKS
1SEE�'. PIT _ CESSPOOL I I
I I I I
1GRA'tWATER SYSTEM
I I I I I I
� ,• it I 1 I I
I II I I I
I 1REPORT ID: DPR266 ' ROUTE TO : BS0508 1 I I I
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUPT 13F BUILDING ADDRESS
FOR APPLICANT TO FILL IN LOCALITY_
BUILDING y� NEAREST
ADDRESS , sip/ {AX Cy' y dA-- CROSS Sr.
LOCALITY DISTRICT NO, SERIAL N0. PERMIT N0. c
NEAREST S
A
CROSS ST µ _ y,
b RECEIVED BY Ready for Inspection I DATE ISSUED
OWNER
MAIL g USE ZONE OCCUPANCY MAP
ADDRESS,-� � i.. y„ _ t �'�..� _w' BK PG
CITY u TEL.NO.
CONTRACTORJ7/ ' .�N��f �. CHARGES REIMBURSEMENT FEE
ADDRESS ' S / r °° REQUIRED _
O. NOT REQUIRED
CITY TEL.NO. /C (�^ �r C:' CONNECTION CHARGE FEE
F
STATE JOB.NO.
REGISTRATION NO. COUNTY CO.IMP. NO. ,
LEGAL RECEIPT NO. I DATE I BY
DESCRIPTION LOT NO. I
BLOCK - TRACT w a; WAIVER FOR RECORDING
SIZE OF LOTr`' N0.OF BL ¢ RECEIPT NO. I DATE BY
NOW ON LOTT j
USE OF
BUILDINGS
NO.i DESCRIPTIt1.N .QF. 1KQRK _ FEE TRUNK PERMIT NO.
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PPUBLICSEWER _ @ $ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
RIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00_ CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AHD/OR DISPOSAL SYSTEM 1.00 I STATION DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL I UPPER LOWER
SPECIAL CONDITIONS ONLY 2.00 t TYPE OF CONNECTION LENGTH FROM
I
`T CURB F.L. M.L.TO P.L.
OWNERS _PERMIT $ L 1 00 -
AUTHORIZATION I TOTAL FEE --
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS._-,' _.----DAY OF. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ----------- ....... BUILDING OR WORK _
ADDRESS_ _ u .. SEPTIC TANK,SEEP.PIT(S)
_ l�----�^�- -_ _:�; - .-_ - ._ � --•-- AND/DR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL El DRYWELL E] I
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO CCMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 DISCONNECT PLUG AND HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY -ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
, ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS E]
SIGNATURE SEEP.PiT(S)E] CESSPOOLS J
OF PERMITTEE..-_ --- 1
76A642H 663 ,12/52