HomeMy Public PortalAbout5931 MUSCATEL AVE_Sewer__ r
APPLICATION FOR PERMIT N
15Ati
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL �+
DEPARTMENT OF COUNTY" ENGINEER
BUILDING, AND SAFETY DIVISION 13U I LDING
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I'OHAI A. LAMBIE. County Engineer DDFt 5e, r / r
WILLIAM A. IENSEN, Supt o4 Building
'_OCALiT Y I
N E AR E'S T
FOR APPLICANT TO FILL IN R� ,S 5r
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0C ISC R.FT'iON 101 NO �" � li ` 3WNE..RAll-
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BUILDINGS ! i'- " ? �'� DISTRICTG GROUP MAP PROCESS
ROCESS.`D BY
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CONTRACTOR
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STATION / , DEPTH
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' L] STATE UPPER
REGiST RATION NO. L� COUNTY MANHOLE REFERENCE �--^LOWER
CF=.S CR;PT ION OF W0FRK ECF.:. -..-.-TYPE:OF CONNECTION LENGTH. FROM
`1OLI F.SEWER C 6NNEC;TING TO CURB P L M.L. TO F L.
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S}FTtC TANK SE.:"AGE PIT OR L P 0
PIT AND,OR Dr.AINFIELD rt' z70 DO 1_MF{ 4C { L
140 15.:SEWER CONNECTING TG TRUNK PERF�IYNO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM
CONN EC` ADDITION AL BLDG OR /FF1DAYi A'L ER i[ASEM EN I RELOAb INS7R NO. DATE
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WORK O HO JSE$EWER @ $3.00
'.. OVER}r1._OW SEEPAGE,PIT,DRAINFIELD � F^4
EXT N.,CESSPOOL.,.DRYW ELL.MA NH OLE @ $5.00 E"
Ak,TFF3. --- -- - t --I - - HWY.OR ST.WIDENING
.I REF AIR 04 ABANDON HOUSE
SE.y ER..Oi DISPOSAL Y57EM _� $J.tlO I
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-- _- TATE ENCROACHMENT
( .. PERMIT Nk .
NDUS RI AL - - -
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WASTE APPROVAL
OWNERS PERMIT $ z CHARGE oa --— – – – --- – ----
AUTHORIZATION TOTAL FEE CONNECT!OIt'CHARGE FEE
'1 HAVE AT THIS DATE A. CONTRACT WITH THE HEREIN NAMED CON- REl--ME3 URSEMENT FEE
TRACTOR 10 CONNECT THE ABOVE DESCRIBED EXI TING DWELLING
TO THE PUBLIC SC ER < �"�'r-� APPROVALS I~I DATA �INSPt'i:'OR SIGNATURE
S€GNED THIS_ . .DAY 0F'�.�� -
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O.WNER'Ok h- ( - NEW HOUSE SEWER
OWNERS tiGEN` / CONNEC 4DDITI ON A[.
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� ?( f� BUI LDI NG OR WORK
ADOREF L
SEPTIC TANK.SEEP,PIT€57
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HERESY ACKNOWLEDGE THAT 1 H YE ROAD TH I$ APPL;CA.ION nND/OR'DRAINF.ELD '
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE To COMPLY
'.MIT hi A..,i_ C.OUh TY ORDINANCES AND STATE; LAWS RrGULATiNG
PLUMBING AND SEW E.R'E. ESSFOd �� DRY'A
I HERE F?Y CERTIFY THAT I AM PROPERLY REGISTERED AND.IOR ALTER REPAIR,SEWER OR
t_1CE NEED AS REQUIRED BY LOS ANGLES COUNTY AND STATE: Elf STEW A,GE DISPOSAL SYSTEM �
CAL,.I F70RN 1A OR. YHA I AM THE LEGAL O, D T "— -
- T + OWNER R.�f}fi, AND INTEND O ._ _
RES!DE IN, THE A.BCI'dE >?�,SCP..;PL!T RF_S!DENYt'p,L PROPERTY. Df Si-01 ! FLL ANO
_ ABANDON HO I;;E SEWER
SIGNATURE p
GK PERMITTEE— E.. 3AC KRILL SEP
T1t,TANKS
_ .F' S; r CESSPOO[.5
VALIDATION ROBERT A. WOOD
C K.. M.O CASH SUPERVISING MECHANICAL. ENGiNSE:R
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