HomeMy Public PortalAbout5933 MUSCATEL AVE_Sewer__ :'EROS 10-63
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU IL.DI NG
Y AbDRESS____.___ 1 ... .'�rS-.wik-1.,`Sr
16HN A. LAMBIE, Count Engineer
WILLIAM A. JENSEN. Supt of Building -q "y
LOCAL.!T'Y ?'tr' tY
FOR APPLICANT TO FILL IN CROSS ST ' e '
L GAL
DESC:REPTION L DT NO ry -- - OWNER
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BLOCK TRACT ADDR ES
NO OF SLOGS.
SIZE. OF LOT NOW ON LOT t7N
TY {. Y,/zTEL, NO.
USE O�
BUILDINGS O. GROUP M.AP PROCESSED HY
BKPGty•�-p�aT vCONTRAC'TORvt .y J�iYj
ADDRESS ` ` 1s " f '° CONNECTION DATA
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11 DEPTH.
STATION -
CITY TEL. NO. _
STATE MANHOLE REFERENCE
REGISTRATION 204111
rkf GOUIVTY it LOWER
NO. GESR
_CRIPTION OF WOK FEE TYPE OF CONNECTION � LENGTH FROM
— -I- — - _---y,
-., -- Y. CURB pi.L. M.L..TO P.L.HOUSE SEWER d'
i
PUBLIC 5EWERCONNECTING TO `� $5.00
_�. __ __ _.__-_ .__ __ ___ P C N9
SEPTIC TANK.5EF_PAGe PIT OR J -� CO. IMP.NO. J08 NO.
_ PIT AND/OR DRAINFLELD C 5.0.00.
1 HOUSE'SEWER CONNECTING TO �- —__rTRUNK PERMIT NO. ROAD PERMIT NO,
DIVATE DISPOSAL SYSTEM____.-_� $3.00 �
��CONNEc:7 ADDI'"CLONAL BLDG OR -- -- AFFIDALIT -wa:vEx _Rei MervT i RECORD.INS FR.NO. DATE
WORK TO HOUSE SEWER @ $3.00
y OVERFLOW--SEEPAGE IT DRAINFI LD
EXTN,C ESSPOOL,DRYWELL,MANHOLE @H S5.00
—--- —
-- --- -- - - '-- - -'- HWY�OR Sri' WIDENING
ALTER,REPAlFZ QR ABANDON ii0U5E
_ SEWER OR DISPOSAL SYSTEM @ $:3.00
..
STATE ENCRORCHtd tNT
PERM;T NO.
.INDUSTRIAL
(.
W.A _-___-
5TE AP PSR OVAL
CHARGES
LAH
WNER`a -PER IT—— ! z? oo - - ---- ----- ------
AUTHORIZATION TOTAL FEE I � CONNECTION CHARGE FEE
VE AT THIS DATE A CONTRACT, WITH THE HEREIN NAMED CON- REMBURSEMENT FEE
T-DR TO CONNECT" THE ABOVE DESCRIBED EXISTING DWELLING -•ry-'- '-------- - ---"--' ----- '----HE PU BLIC SEWER. APPRO�J"ALS __.___.-� K.A7e. INSF ECT OR 5!GNAT-URE
N€Q THiS ._DAY OF' ____.--_' �._ER ORNEW HOUSE SEWER
S S AGENT _ _ �_. --- --- ONi'JECf ADD1SIONALRE'S BLD NG OR WORK S[PTIC TANK,SEF'P P!T(5)
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS .APPLICATION AND/OR DRAINFIELD aTATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY ALL. CO NT'Y ORDINANCES AID STA'iE LAWS REGULATINGMBING' ANL SEWERS. CESSPOOL ❑ DRYWELL 0 '
HEREBY' CERTIFY „-THAT I AM PROPEP REGISTERED AND/OR ALTER REPAIRSEWER OR
NSED AS RFQt,sfRED BY LOS ANGLES COUNTY ANDSTATE OP SEWAGE DISPOSAL SYSTEMIFORNIA 0R, (IAT I AM THF LEGAL OWNER OI` ANb INTEND TO N 7ANDIDE N, T}9)eA8 VED R10ED ft jF1'E-CJ AL.fl'CPE R"Y ABAtI00N NOUSE E4>.ER
A TJ RE g"r4� �__---PERMITTEE �'� E` 1 -_- BACKFILL SEPT K,TANKS
_ - ___ SEEP,PIT(j) CESSPOOLS 31
' VALIDATION-_ ROBERT A. WOOD
J
CK. nn o CASH SUPERVISING MECHANICAL ENGINEER
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