HomeMy Public PortalAbout6038 MUSCATEL AVE_Sewer__ 6A64422D o.-63' APPLICATION FOR PERMIT'43
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COUNTY OF LOS ANGELES SEWER-SEWAGE ®1SF'C?SAL �
gEPARTMENT OF COUNTY ENGINEER
BUILDIiVG AND SAFETY DIVISION FADDRFSS
JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Supt of BuildingNEAREST
FOR APPLICANT TO FILL IN
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D E S C R'PTIONLOT NO. rr ._.— _ OWNER
_ MAIL
BLOCK TRACT t/fj8 ADDRESS,
SIZE OE L07 Ia v €.�"y,. NOW ON LOT —. _ CITY TEL, NO,
USE OF
BUILDINGS -,; �' DISTRICT NO. GROUP MAP PROCESSED BY
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CONTRACTOR Ye T r
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ADDRESS �4 _ I CONNECTION DATA _—
""`- STATION DEPTH
CITY
MANHOLE REFERENCE UPPER
REGISTRATION NO. ) ;y dr�)p '� COUNTY LOWER
NO. C ESC_RIP'TION OF WORK FEE _ TYPE OWCONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO � �r � Y. CURB P,L, M.L.TO P.L, -�5...
PUBLIC SEWER $5.00P.C.NO,
SEPTIC TANK,SEEPAGE PIT Y j JOB NO.
PIT$AND/OR DRAINFIELD $10,00 CC). Imp.NO.
HOU SE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
—�� .
�i PRIVATE DISPOSAL SYSTEM $3.00 I �
I CONNECT ADDITIONAL MWORMCgr i1 AFFIDAVIT' welvrR tASelwskr RECORD.INSTR.NO. PATE .
I WORK TO HOUSE SEWER @ 53.00
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OVERFLOW SEEPA PIT.DRAfNFtlELD
EXTN,CESSPOOL„ORYY+F.LL.MANHOLE A3.00 ,
._ ____ ___..—ABAN _.___—____.__._�T- i HWY.OR 57.WIDENING j
ALTER,REPAIR OR ABANDON HOUSE
15E`:!£R OR D1SPQSAL SYSTEM @ $3.00 STATE ENCROACHMENT z
PERMIT NO.
INDUSTRIA_
-- WASTE APPROVAL
OWNERS PERMIT B� 2 00 CHARGES —
.___._. CONNECTION CHARGE FEE
AUTHORIZATION
-1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---- - ------ ----------r--"------- - ---'---
TO THE PUBLIC SEWER. APPRO PALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS____ DAY OF i9— -.._--– '--------'T ---i---------_-----
OWNER OR NEW HOUSE SEWER
OWNERS AGENT. rf —
CONPgECT ADDITIONAL
BUILDING OR WORKA
—�— - -- — -�--�- SEPTIC TANK,SEEP,PIT(S) i -
I HEREBY AC.KNO111i..ED..L" THAT I HAVE READ THIS APPLICATION ANN/OR DRAINFIELD t
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ._ - --_---------L— -----t----------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 1
PLL;MBING AND SEW eRS. CESSPOOL ❑ DRYWELL ❑ ! li
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS RE:.IUIRED BY LOS ANGLES. COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM {
CALIFORNIA OR THAT f AM THE-SEAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DE5CW1BED RESIDENTIAL PROPERTY, gEfAN DON HOUSE S.EWFR
SIGNATURE ' �'
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OF .PERM ITTFE - BACKFILL PULS€P El TANKS I
—'x -`” % — ------ SEEP.PIT(S) CCSSPc;
VALIDATION ROBERT A. WOOD
SUPERVISING. MECHANICAL ENGINEER
CK M.O.. CASH
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