HomeMy Public PortalAbout6003 MUSCATEL AVE_Sewer__ ,sAR ��Y APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Bepaxtment of County Engineer
County of Los Angeles BUILDING0 yepy
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JOHN A. LAMBiE,COUNTY ENGINEER -�bpR£SS 514 !V -
CASSATT D.GRIFFIN, SUPT of BU;LDINO LOCALITY �'s82^ .el
'AREST
FOR APPLICANT TO FILL IN CROSS ..":T. Geri baea E79 d
LEGAL
bESCRIPTION LOT NO �,�4 OWNER Ralgnsotelo -_ —
--- -- --- -- 1� _' -
MAIL /� 7 �� ,}�, ^�
BLACK 'TRACT -;; ;I I ADDRESS---- ' '�E -370_�t__1i'i'�rss'e�k!�".i.
`= xNO.OF BLDGS. -- iJ�' �� #Ml�w G.°"M.6. .
S(ZE.O= LOT .'"� �, NUW ON LOT CITY TEL. NO,
USE OF -__._-___------- DISTRICTN,
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CONTRACTOR ".. _ bI .00-w-.�__-�- _�f V "' ".. o
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ADDR£rS _l.6.?.+ w Huntington. Dr, — _
C[?" ' �t' S -- TEL. NO. 41-78146
-STATION',; r I¢ f / DEPTH ;
---- ------- - MANHOLE REFERENCEf,��F {., UPPER
"�' p� STATE �'!N, - `�r... ^L RlT=tt
REGISTRATION N0, f 78;1()---- --COUNTY -------- ft -
NO. j DESCRIPTION O4- 'e OPK FEE ---- ----. -.---__ __-- !— -
- - --- -- TYPE OF N'vf ,jION LENGTH FROM 6?
PUBLIC
StV ER CONNLCiING TO � Y_ °CURB P.L. M L.TO P,L.
PUBLIC SEWER C $3��� ;<�� �' _� = -_ _--_ R �----
SEPTIC TANK,SEEPAGE PIT OR !
PITS AND OR DRAINFIELD 2; $3.(Do: I ---- -- -- -_-- __
OVERFLOW SEEPAGE PIT,DRAINFIELD -.s P C. NO.
----- c, .`!.,CES_PGOL,DRYt4ELL,MAhHOLE z a`2.00 j j _CO.IIP.NO_
HOUSE SEWEJR CONNECIING TO
PRIVATE DISPOSAL SYSTEM (t I.00 TRUNK PERMIT NO, _ ROAD PERMIT No
CONNECT ADDITIONAL BLDG.OR -._ r-_-- --- ..
STATE ENCROACHMENT
]aORK`I'0 ,MOUSE SEvam i.` S 1.00 PERMIT NO.
ALTER..REPAIR ORABANDON HOUSE i i ------ ._.---- - --.
i SEW ER GR I�a.OSA SYSTEM, �a S.I.0c INDUSTRIAL
._-_ - -- WASTE APPROVAL
- CHARGES
i
_ I_...__�_ CONNECTION CHARGE FEE
OWNER'S PERMIT -$ :t I UO -- ---- - --- ------
- - -
,; - Rcl19k URSkMENT FEE -
AUTHORIZATION TOTAL FEE
I HAVE AT HIS DATE A fONTRACT WITH THE HEREINNAM£G CON- APPROVALS !ATE j INSPECTOR SSICNAT'URE
TRACTOR. r0 CCNNV '---T 114E ABOVE DESCRIBED EA-STING DWELLING �To THE PU",LI_ _.rVER. NEW HOUSE SEVER
S!GNED THIS-__-____.-LIAY dE--- - _-i9 CONNECT ADDITIONAL
QWNER JR
-.BU1l.DINC'0R WORK - --- ---
ONNERS AGENT � SEPTIC_ _.'.x `] ..� 's" ---- -- TANK,
`;EPT C TGF!+,SEEP,PIT(S) -- - - -
`'' AND i'OR Di AIPdr IE,.D
ADL9RE.SS ._.._ - -- .. -- �. - ---_-_J------- -------- ----
1 'rF•2f 3Y ACYNOYv LEDGE rr_AT I HAVE READ THIS APPLICATION -
AND STAIE: THAI THE ..BOV:E !S CORRECT AND. AGREE TO COMPLY AGREE z.PYNtLL L]
VViTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AI'I- SEIA'FRS. SEWA DISPOSAL.SYSTE.'d___ � ..
Y H£RcnV CERTIFY THAT, I AM PROPERLY REGISTERED AND/'OR DISCONNECT?LUG AND
LICENSED AS REOUTRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED P.ESIDE.NTIA'._ PROPERTY, BACKFILL SEPTIC TANK'S i7
SEEP. Pi I(S) ! CESSPOOLS L�
SIGNATURE '-----
OFPrRM.ITTEE___.-^--= -`-- - -- --
JOHN A. LAl'IBIE, COUNTY ENG;NEER VALIDATION ROBERT A.WOOD, CHIEF RLBG. INSPECTOR
CK, M,Q. GASH _
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