HomeMy Public PortalAbout5927 MUSCATEL AVE_Sewer__ APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
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IOHN A. LAI�STE, County EngineorWILLIAM A. JENSEN, Sup"t of Bu€ldingCAL;TYARE'iTFOP. APPLICANT TO FILL INRGS, ---
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I GAL
DESCR TION LOT NO �J �� :' t OWNER
MAIL —
BLOCK --TRACT �; �g¢„ ADDRESS
NO OF BLDGS. °-
S!Z£ OF OT ROW ON LOT
:CITY Y` - TEL. NO.
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IN
GS t -- _ D.STRi CT NO. GROUP MAF' PRGCES°.SEj7,;BY
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CONTRACTOR )
ADDRESS
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CONNECTION DATA
STATION /
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STATE MANHOLE REf`E'ENCE UPPER—
REGISTRATION NO. [� COUNTY LONER
. -__"_____- --_-_H—FROM_.__—_-._.
N4. !. GESCR.PTION OF °�'VORK f"EE TYPE Of CON NECTfON LENGT
HOUSE SEWER c'ONYtCTit'.J:G T'_Q.---___ �..-.__ Y. CURB P L. M.L.r0 P.L.'
PUBLIC C 5EWER. n.OQ ,.
SEPTIC TANK.SEEPAGE PIT OR ���- 1; O
G9 1`WP N ✓ JB 1v0
PITS AND/OR IDRAIC t fE[D @ slo.00
1 HO SE SEER CONNECTING TO TRUNK PERN�17 NO, ROAD PERMIT NO. _y
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADD f1ONAL BLDG OR ~---�--- AFfIDA J T WA[V ER EASEM ENTS RECORD,iv7STF NO. DATE
WORK TO HOUSE SEWER !r@ $3.00 � �
;�, OVERFLOW SE E!'AGE PTT,DRAIN FIELD
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EXTN„CESSPOOL,ORYWEL.L,MA NH OLE $5.00
____- ------- HWY..HWY". OR ST.WIDENING -.
f r AL tt,'F< ..,-R ABANDON HOUSE
f W anLSYSTEM ''' -3.00 - -"_- ____ STATE ENCROACHMENT
-J ! PERMIT NO.
i WASTE APPROVAL
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OWNER7S PERMIT ------- c -- 1-00
--_— eHAHGEs
AUTHORIZATION TOTAL. FEE CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CON'YRACT WITH THE HEREIN NAMED CCN- REIMBURSEMENT PEE
TRACTOR TO CONNECT THE ABOVE. DESCRIBED EXIST LNG DWEt INC -- -- - - - - -(-- -----r ---- - -'-
TO THE PUBL� SEV,ER. ' - ��Ca APPROVALS I DATE 1.1N5PECTJN 5 SIGNATURE
SIGNED THIS DAY OF
-
OWNER _r-y—�,. 9 °:� — - -- - ---- -- -�-----�- --- ._— '--
OWNEROR '- I �� NEW HOUSE SEWER
OWNERS AGENT
ECT
.AGORE55'.,..�t' BUILDING/ AL
OR WORK
SEPTIC TANK,SEEPP'T(S)
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS"APPLICATION AND/OR DRAINFIE:LD �
AND STATE THAT THE ABOVE i5 CORRECT AND AGREE: 1'0 COMPLY
WITH :ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL 17) DRYWELL [�
1 HEREBY CERTIFY THAT I .AM PROPERLY REG:'STERED AND/OR ALTER, REPAIR,SEWER OR
Ic.
INSED AS REQUt RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM j
C,F LFORNiA OR THAT 1 �!vl 7NE LEGAL OW NE[z''OF, ANDINTEPiD TO ---. ----
D 15CONNLCCT PLUG AND
RESIDE IN, THF' AI?OVE L.F Cfi L'� RE S4 DE N,,-tl AL PROPERTY, ABANDON HORSE SEWER
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SIGNATURE -. BACKFILL SEPTIC TANKS
_"C�-
OF ERM!r7 L / _-��..�
SEEP,P (.i) CESi S
VALIDATIOI�t ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
' CK. F/ M.0_ CASH