HomeMy Public PortalAbout6207 MUSCATEL AVE_Sewer__ :E808 2-7a
fi42.[� APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEINER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAODRESS
DING 16/
JOHN A. LAMBIE. COUNTY ENGINEER sCOLEMAN W. JENKINS, SUPT. OF BUILDINGLITYESTF'OR APPLICANT TO FILL IN S ST
'PRINT OR TYPE ONLY) —_--
DESCRIPTION LOT NO OWNER .f' �:t r.
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
Use OF -----------_—__--
BUILDINGS DI$T.RIC.T Wu. GROUP CLASS PA A.P PROCESSED BY
_: BK P5
CONTRACTOR
ADDRESS .-- -------- CONNECTION DATA
—CITY TEL. NO.
STATION DEPTH
SrATE_—______._ .--"—�_—'.—LIC MANHOLE REFERENCE -- —__----_UPPER
L?CENSE NO: CLASS LOWER
NO. DESCRIPTIONOF WOkRK FEE ----._-------- - --------------i�.--
_ S_ _R__ TYPE OF CONNECTION LENGTH FROM
HOUSE EWECONNECTING TO Y. CURB P.L. M.L.TO P,L.
B
PULIC SEWER .$5.00
SEPT
._-_____—TA
AN N
--K,SEEPAGE PIT P.C.NO.
OR
PITS ANC/OR GRAINFIELD @ $ CO.IMP. NO, JOB NO.
HOUSE
HOUSE SEWER CONNECTING G TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00 {
C1..
CONNECT ADDITIONAL tiLA.@n•@Mt �^ "-: .r� AFFIDAVIT wAlvtR—l—[FS—EM€NT RECORD.1N5TR.N0. DATE
WORK TO HOUSE SEWER @ $3.00j� U
OVERFLOW SEFPAGE PIT'.DRAINFIELD
EX7N C CS SPOOL,G RYWELL MANHOLE @ $5.00 '` /y
-- REPAIR - - '--- HWY.OR ST.WIDENING 0
ALTER OR ABANDON HOUSE !C
SEWER OR DISPOSAL.SYSTEM @ $3.00 --'--' --'--'�'---"- —+'
_.jSTATE ENCROACHMENT J -. ,' u
PERMIT NO. -----
CL
INDUSTRIAL
WASTE APP ROVAL_.� _- z
CHARGES — —"--
OWNERrS PERMIT�+�— ----- - ---
7I TTs�eODTZAe�e*Q*y T®TAT. [LE _ CONNECTION CHARGE FEE
i A V l RI 1 t dY
'i I. HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIM IURSEMEE//N��T FEET��se
TRACT"OR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
— -�APPRVVALr7T—� —
'TO THE PUBLIC SEWF-R, DATE I INSPECTOR'S SIGNATURE
SIGNED THIS.—,DAY OF-_.__._ f9, —"----
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
—"— -- CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK
- ---.-- -
- �� - — -- -
SEPTIC TANK DEEP,PIT(S)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRArNFlELD ( I
WITHALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ~
PLUMBING AND SEWERS. CESSPOOL [I DRYWELL j
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AL ER,REPAIR.SEWER OR
L. _ENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I` -
LIFOR
WA OR THAT I.-f,M THE LEGAL OWNER OF, AND INTEND T4 '----'----- h —
! DISCONNECT PLUG AND RESIDE IN, THE A801rE,DESCRI BEO RESIDE[LTIAI,�.�FROPERTY. ABANDON
HOUSE SEWER
SIGNATURE
OF PERMITTEE j — BACKFILL-SEPTIC TANKS
i
'• (S) [� CESSPOOLS QI ,
VALIDATION JACK R. ALLEN
5 SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH)I__.:i,
k
6A 82 70 APPLICATION FOR PERMIT .E
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL L
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Buli.uiN N
JOHN A. LAMBIE, COUNTY ENGINEER AbcFtESS
COLEMAN W. ,JENKINS. SUP'T. OF BUILDINGLocALITr
— ---
Rw
APPLICANT TO PILL IN CROSS-5
r — _ d-i -- -%-"- =r
- T
---�
DES:' PT!ON
LOT NO
MAIL
BLOC_K - _ TRACr _ d 57 yf _ — ADORE55.__
NO. OF BLDG-S.
SIZE OF LOT NOW ON LOT CITY - T'EL.MkO.
USE OF d
BUILDINGS }�� I 'Ri C. NO CPROCESSED B.
f
BK
�RUPJCLASS '-MAP P PRO
S 1' ry - Y
�_ s' /} p
CONTRACTOR u!""i®• — d' �If/" �>J I P.✓' i e.., .k,,.✓F`'-,•
ADDRESS g "� � '� n� __. WObl ilECTION DATI'b.__.—______ _
CITY {�s� d. STATION *� �py�J DEPTH
STAT£ �:. LIC UPPER
f^S s MANF{C)LE REFERENCE <.V
!_%CENSE NO, _ {,�f E. CL ASS ti, F
NO. �)= C P7I61J OF WORK FEE TYPE OF �'SN NE "f`ION LENGTH FIR M --�"
HOk,SE k,W R 0 N N E C T I NG TO Y. URB p.L. M.L.TO P.
._j SI_S G tAnKSEEPAGE-FT OR — T_T_. } " -� P.C.w0. ----_—
I4- $Io.00 CO IMP No:^ Z JOB NO,
PITS 4N0/OR DRAIN IELD fpa
I `i O+ SE SEWER CONNECTING"O TRUNK PE.RMiT NO ROAD PERMIT NO.J "
FR14AT E DISPOSAL SYSTEM $3.00 .
CONNECT ADDITiOw AL Bt DG' OR - AFFtDAVPT WAIVER!-EASEw ENr RECORD. INSTR.NO, DATE
WONT TO HOUSE SEWER Q $3.00 Illi �� 11
—. _
OV Rf LOWS CPi-`GE YIT DRAIN FIELD
EXT N CESSPOOL DRYWE L MAN}{OLE $5.OQ HWY.OR ST..WIDENING
'
ALTER.REPAIR OR ABANDON -
_.,_-_I
EWER OIs CISP05,.4 SYSTEM _x_$3_00_ .T_ STA7EEw CR OACHMENT f�
'T- ._- _— PERMIT NO.
INDUSTRIAL
WASTE APPROVAL z
{ ��ry��+H CHARGES __—_--
��+OyNlt�lyiyGyiitl�fS+g �,p PEaRMI $ OO
____________CHARGES
�__—_
AUTHOMATION TOTAL FEE ( S. OON NECTiON CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FpyEEp}�t
'RACr-`R TO CON"'IECT THE ABOVE DESCRIBED EXISTING DWELLIwG AtL"RO0.tALw7— --TT
TO TFt'E S'UBLIC. SEWER. ,�q,, �y �� DATE INSPECTOR'S SIGNATURE
Si Gil F^J 7I-k IS �a::? .,DAY OF_� .Y�� �...�.to ---- —_ ---
OWNER OR a gfv NEW HOUSE SEWER
9
OWNERS All— CONNECT ADDITIONAL ��
_ BUILDING OR WORTSADDRESS-
T
SEPTIC TANK,SEP,PIT(S)IIIERLUY .ACKt O V6E0G "i I HAVE REAL) THIS APPLICATION AND)6R DRAINFIFLD
AND `T TE THAT THE ABOVE d5 CORRECT AND AGREE 10 COMPLY- —.-- --------.-.--_-_.� —.—
WITH ALL. COUNTY ORDINANCES AND STATE !_AWS. REGULATING I^�
pj_UMHING AND SEWERS. CESSPOOL � DRYWELL � —.—y
HER. BY CERTIFY .THAT 3 M FR9 PERLY REGISTERED AN fOR ALTER,REPAIR..SEWER OR f
Lll EN SE AS REQUIRED BY LVS ANGLES COU N7Y STAT OF SEWAGE DISPOSAL,SYSTEM
CALFORN IA. OR THAT I AM T LEGAL OWNF..R OF, AN INTE O.Td) -- '—
RCS'"DF IN THE ABOVE DESS IF)'ED RE5IDE NTI AL PRO RTY t'6.,CGSNN CT PLUG AND
ABAND¢N HOUSE SEWER
",- 1 a. ------
SIGNATURE
HJ
OF Pf«RMYTTEE A IL SEPTIC TANKS
.— - -- EP,P11 c5) [] CESSPOOLS �,+' r I _; ;{
_ - _
-,VALIDAT116N JACK R. ALLEN
SUPERVISING MECFir`WCAL ENGINEER
!` CK. M.O. CASH
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