HomeMy Public PortalAbout5910 MUSCATEL AVE_Sewer__ 66A642 X62 APPLICATION FOR PER IT
' A642D 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �� �
COLEMAN W. JENKINS. SUPT. OF BUILDING (/^`_�`
LOCALITY S,' \..'r.
NEAREST
FOR APPLICANT TO FILL IN `ROSS 5T.
LEGAL___ - ,p'� F
D_ESN
_CRIPTIO _ LOT NO.,-;-"/ I'�p yam' ��' j�. OWNER
MAIL f
BLOCK _TRACT, ADDRESS
SIZE OF LOT NOW ON LOT CITY "I TEL. NO.
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS '�
BK PG
y _
CONTRACTOF�
ADDRE S CONNECTION DATA
CI TEL. s�'1 °,�;,J' STATION DEPTH
STATE MANHOLE REFERENCE _ U
OWR 'L,C.ENSE NO�.0 �. ® CLASS vL
N i— .DESCRIPTION OF WORK FEETYPE OF CCJ.[aLdI,ECTION LENGTH FROM
HOUSE SEWER CONNECTINGTO Y. V CURB,s P.L. M.L.TO P.L. r`
I PUBLIC SEWER —_C4_$5.00 --- P.C.NO, 0-
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
FRIVATE DISPOSAL SYSTEM @ $3.00 pvi
CONNECT AOWTIONAL BLDG OR —� j AFFIDAVIT WAIVER I EAS EYENt RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00 I qj
FS .
OVERLOW EEPAGE PIT.DRAINFIELD �_
L
EXTN..CESSPOOL.DRYWELL,MANHOLE @ $5.00 ! Ln
_._-_ -___-__---_ -___.-__� .__ — - HWY.OR ST.WIDENING y
ALTER.REPAIR Oft ABANDON HOUSE � .L
SEWER OR DISPOSAL SYSTEM@ $3.00 � STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ----- --- -
1 HAVE AT THIS DATE A CONTRACT WITH THE EIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIB EXISTING DWELLING -- - -- --------
TO THE PUBLIC SEWER. APPROVALS TEN PECTO T S 31GNATURE
SIGNED THIS DAY OF 19_,- --- —�—
S f;
OWNER OR y NEW HOUSE SEWER is ' N•'+..,,.1
OWNERS AGENT,_ �VV••�1��,,,•+ti•,�� CONNECT ADDITIONAL
BUILDING OR WORK
ADDRES5. ------ - JJ
— -"--------'--'--------- ------ SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR 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 Cl
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENA )I'S REQUIRED BY LOS ANGLES COUNTY AND STATE OF 5 EWA.GE DISPOSAL SYSTEM
CALIF RNI OR THAT I AM THE LEGAL OWNER OF, AND INTE D TO DISCONNECT PLUG AND -I�
RE F 1 THE ABOVE DESCRIBED RESID TIAL P Y.
- ABANDON HOUSE SEWER
SIGNA RErt"Y`�- _-- — — -
0 � BACKFILL SEPTIC TANKS
EP.PIT(S) ❑ CESSPOOLS ❑
VA IDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH