HomeMy Public PortalAbout6125 MUSCATEL AVE_Sewer__ E��0 11,
76A642D APPLICATION FOR PERMIT
COUNTY OF LOSANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
A D D R E S t
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN. Sup't of Building
LOCALITY
REST
FOR APPLICANT TO FILL IN -ROSS ST.
LEGAL
I O`r 4
14 - OWNER
MAIL
BLOCK TRACT
ADDRESS
NO. (.�F B!DGS.
SIZE_OFLOc' CITV TEL- NO.
US, OF
DISTRICT NO, GROUP MAP PROCESSED BY
aK PG
Bt"L DING
R_S_
AOO 9
LOCALITY
D- L"Y
N".R EST
CROSS OF
3 �
-
CONrfRACTOP
I yj.", 4
-S
RE:SO CECTION DATA
ADD
TATION DEPTH
CITY TEL. 2
-Y,
SLATE
A;-F FR--
COUNTY MANHOLE R!,�FFIRIENCIE
RE1,;IS1RA,iON NO. ;j : Z'
TLOWIER
DC-i`IFITION 0 WORK FEc
TYPE OF CONNE.r;Ty61N LENGTH FROM i
Nt`1;-1 F"N v q c 1)N'NN K- 7 1 N G TO YLP.L. M-L.TO F.L.
PU8I.AC SEW @ 3"01) 0
SEPT 1C TANK-SEEP PIT 0.4
PITS
AND OR DRAfNFIELD @ STOOOCO '.MR.NO JOB NO.
-----------
HousT,5 wE0Nt1 T1 :G To TRUNK PERMIT NO� ROAD PERMIT NO.
PRIVATE U:SPOFIL SYST"EM
0
-C;
WORK TO HOUSE SEA FR -AF MW WAIVER—I RECORD. N&TR.N.J. F
CONN' T ADDM(ONAL BLDG:OR
@ $3.00
OVERF LOW SEEPA'GE PIT,DRAINFIELD
f rXTN::CESSPQO:-DR eWELL,MANHOLE @ $s.00
-
HWY.OR ST.WIDENING
ALTER.REPAIR OR ABANDONHOUSE
SEWER OR DiSrOSAL SYSTEM @ $3.00 ------- --s�ATE-6�cRoAcc-HmrNT
PERMIT NO.
T INDUSTRIAL
WASTE APPROVAL „ y
-b
CHARGES
OWNER'S 2� 00
AUTHORIZATION TOTAL FEE y I CON,4ECT ION CHARGE FEE.---
I HAVE Al THIS DATE A CONT:-TACT WITH THE HEREIN
NAMED CON- _URSEMENT FEE
TRACTOR TO CO.NNECT THE ABOVE PESCRIDED EXISTING DWELLING
TO
THE PUBLiC SE'WEIR. APPROVALS I DATE INSPECTOR'S SIGNATURE
SIGNED THiS---DAY
OWNIR OR
NEW HOUSE SEWER
OV.N E R S A GY N r--- -------
CONNECT ADDITIONAL
i
ADDRESS BUILDING ORWORK
SEPTIC TANK,SEEP, PIT(S)
HFRESY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION
AND)'OR DRAINFiELD
ANDSTATE THATTHE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH A"L COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMS!" AND SEWERS. CESSPOOL ❑ DRYWELL j-
- — 1iv,
I HEREBY CERTIFY THAT I AM PROPERLY EALTER
R
GISTERED AND/O- RTiA!R SEW ,OR
LICENSED AS RCQUIREP BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
OR
NFA OR THAT
I-EGAL OW AP,4Q, INTEND TO DISCONNECT PLUG AND
R F.5jDE IN, THE AB
"WE DES;,:RIBED RES;vtp �`PRO,FERTY. ABANDON HOUSI- SEWER
)GNAIURE
OF PERM!TTEE BACKPILL SEPTIC TANKS
SEEP,PIT(SI CESSPOOLS
VALIDATION ROBERT A. WOOD
M.O. CASH SUIPERVISING MECHANICAL ENGINEER
`E°°83 52
76A642.0 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ,EWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �
ADDR`cSS `f
JOHN A. LAh2BIE. CosaaT4y Engineer - t ZI - ;4s
WILLIAM A. JENSEN. Supt of Building �� r
LOCALITY
NEAREST
FOR APPLICANT TO FILL. IN ERn-5T.
« - - � — ----
}}�� ----- '- __ p ¢g --- --- -
DESCf IvPTLION L_.OT NO, MAT'
t.I _�-� s� _ OWNER
BLOCK TRACT /�;: �; ADDRESS
NO
. OF
BLDG S
SIZE O LOT' NOW
ON LOT CITY TEL. NO
USE OE
' PR^"p157RICT NO. GROUP MAP
@UI.LDINGS _ - ..�ES5EG BY
PG
BK
CONTRACTOR '
g
ADDRESSCONNECTION bATA t
" I„ ,� n'" �9"!'AT.ON DEPTH .H i
CITY TEL ----r--�� 5TAi /.-,Y
e-
_, E MANt. .f��3°PF-R .
REGISTRATION NO. _. k ° L COUNTY LOWER
—_ _
Np. DESCRIPTION OF WORK FE -- —
E TYPE OF 1ONN EL7S - LEND. H FROM — --
HOUSE SEWER COAhE TING 7p Y t..Cl..F♦>3. ) P M.L.TO P L, a"
_4 P JBL C$EWER .G� $5.00
_— .-. __— ..—._-_ __._- ..�_. {
EPTIC TANK.SEEPAGE PIT OR i —.'—__ i _ P.C.CNO. 0
P TS AND/OR DRAINS' ELD @ $10.00 CO, I'M NO. JO.II.IW O. —
HO 'SE SEWCR COhtNE TING TO TRUNK PERMIT NO t ROAD PERMIT NO PRIVATE D SPOSAL 5 STEM �� 53.00 .��
-_— .._ __._
TCO 1NEC.T ADDITIONAL BLDG OR AFFIDAVIT Y+Aiv Ek [ASEw.tkT r RECORD.iNST'R.NO. i DATE
I WORK TO HO SESEWER @ $"1;OO i
! OVER.F LOW SEEPAGE PIT.DRAiNEIELD
I EXTN..CES$pOOL.DRYW£LL.MANHOLE @ $5.00
AlTER'T2
. ' PAIR OR A - HOUSE— —._ —t---_ HWY.OR ST.WIDENING -
BA hDON
LsEW L'R DI PJSA SY
5'EM STATE ENCROACHMENT
fg` PERMiT NO.
4-- INDUSTRIAL .,�� 1 r ly ..
I
i WASTE APPROVAL ,f r 1
CHARGES
OWNER'S. PERMIT 2
AUTHORIZATION TOTAL FEE CONNECTION C'A Ri"C FIE
1 HAVE AT THIS DA'?'£ A CONTRACT WITH THE HEREIN NAMED CON- REIM -JJRSF.MENT FEE
TRACTOR TO CONNECT THE ABOVE;DESCRIBED EXISTING DWELLING •-- --p—p-��y — --- --- ---"�" --- - — ------
Ta.THE PUBL C SEWE'.R. APPRO Y AL DATE f INSa EC"fOF?S SIGNATURE
SIGNED THIS__.. DAY1�....---- -
OWNER OR IL + NEW HOUSE SEWER
OWNERSONNEC T ADDITIONAL
BU LDING OR WORK
SEPTIC TANK.,SFER, '
(S) -
I HEREBY AC'KNf WL.EDCE THAT I HAVE READ THIS APPLICATION AND,'OR DRAIN`WIELD �
ANO STATE 'THaf THE ASCVE IS CORRECT AND AGREE SO COMPLY
WITHALL COU NTY ORDINANCES AND STATE. LAWS REGULATING
PL UMa ING AND SEWER'S.. CESSPOOL [] DRYWF.LL ❑ '
I HERESY CERTIFY THA ,L-AM PROPERLY RF-GISTERED AND/OR ALTER',REPAIR.SEWER-ORu--.-�-_- _—
LICENSED AS REf.WRED�'F LOS ANGLES COUL TY AND 'STATE OF SEWAGE 0!5P 1'SAL SYSTEM ' y
CALIFORNIA OR THAI is N THE LEGAL OWNER SOF AMID INTEND T:� CLQ- — --'— '-�� "— ---'-- -
g� - DIS NN CT P!UC., AND
RES iDE IN THE .ABBDV tai DEar B:E0 RESILXIWTl PR�1PE1:•77Y. ABANDON HOUSE SEWER
E M1�
SIGNATURECE � ri tJ'
------
BAC
—-
BAC'➢FPEHMTCTFE KFIL SEP':C TANKS
PST f'u1 CES:SPOOLF
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEF
CK. M.O. CASH d