HomeMy Public PortalAbout5812 MUSCATEL AVE_Sewer__ CESOa 3.62
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
I'OR ADDRESS
.N A. LAMBIE. County Engineer AVENUE
WILLIAM A. JENSEN, Supt of Building
L LOCALITY
-A
FC111:G.. ST.
FOR APPLICANT TO FILL IN
LEGAL-
SLOCK TRACT -e An DRESSAT
E31.1
-1820,3 R.-1- ZLDR1VZ
NO OF ELDGS.
SIZE OF LOTX L.'--t"NOW ON LOT- CITY RA TEL. NO.
USE or
BUILDINGS P05 I DEE NT CE O's"'ICT NO, GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
AI Mly
--M
AOORFS5 CONNECTION DATA
C' 'r, 51A T 100 N DEPTH 6 FT .� STATE
REGISTRATION NO COUNTY MINHOLEREFERENCE' R
-162-7B-6- 140
DESCRIPTIOFEE N OF WORK TYPE.OF CONNFCTiON LENGTH FROM
E C CURB P.L. M,L
HOUSE--S SEWER ONNEC:�ING T Y ---_TO F'.L. '5
WLR
@ &.00
SE -- P.C.NO. otj
--
5E ,.CTA Nk'-s7cEFAG-E`-p1'-TOA9- CO IMP. NO, JOB NO.
PITS ANID/OR DRAiNFIELD
HOUSES WE'R CONNECTING TO
FIRWATIE DISPOSAL SYSTEM @ $3.00 TRUNK FERMI'NOROAD PERMIT NO
CONNECT ADDITIONAL SLOG,OR A F F I DA i i:]-.A-1 V-i-R-l'-EA-S-V X-E-N T--Ri:6. 1 N 6 TR.N-0.
WORK TO HOUSE'-;EWER $3,00
OVERFLOW SEEPAGE-IT.DR.AIriFIELD
EXT N-CES DRY WELL.MANHOLE rq? $5.00
t ------ HWY.OR ST.WIDENING
ALTIER. R dR fiEANDON HOUSE
@ $3.00STATE FNCROALHMENT
PERMIT NO.
INDUrTRIAL
WASTE.APPROVAL
OWNER'S---� ISEBMIT .21 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION[-TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT wirH 'THE HEREIN NAMF-0 CON- RE-IMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE I'U SLK- SE11EA11.1 APPROVALS DATE INaPfCTOR'SSIGNATURE
SIGNED THIS. 11�-DAY OF U -4
-
OWNER OR NEW HOSE SEWER
e, CONNECT ADDITIONAL
OWNER.?A<-
BUILDING OR WORK
ADD FLSS—
SEPTIC TANK.SEEP,PjT(S)
H FREBY ACKNOWLEDGE THAT I HAVE REAL) THIS APPLICATION AND OR DRAINFIELD
AND STATE THAT T HE T E ABOVE. IS CORRECT' AND AGREE TO COMPLY
CI
WITH ALL COUNTY RDINAN C E�i AND STATE LAWS RE'GULATINC -
PLUMB ING AND SFWERS. CEI,SPOOL DRYWELL
1 HEREBY CERTWY THAT I AM PROPERLY REGISTERED AND/OR ALTER-REPAIR,SEWER OR
LI
LENSED AS REQUiREb BY Lp-$' ANGLEt COUNTY AND STATE 01 SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM -ZHt LEGAL OWNER OF, AND INTEND TO
DISCONNECT Pf UG AND
RESIDE IN, THE ABOVE: DESCRIBED RESIDENTIAL PROPERTY.. ABANDON HOUSE SEWER
SIGNATURE BA1.-KFILL SEPTIC
OF PERMITTEE-- k- - -—yt-� TANKS [-j
SEEP.F
'(TfS) 0 CESSPOOLSI.
-VALIDATION ROBERT , WOOD
SUPERVISING MECHANICAL ENGINEER
K. M.O. CASH