HomeMy Public PortalAbout6231 MUSCATEL AVE_Sewer__ 76A4APPLICATION ION FOR PERMIT
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S&E.6666 3 Y2-54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D!SPOSAL<
Department of County Engineer
County of Los Angeles 7AE
1 ,}. � w,
t�l(M.J. FOX, COUNTY ENGIH> ER t, y : y ? °' "-
CASSATT D. GRIFFIN.SUPT OF BUILDING I'OR APPLICANT TO FILLI — ��, °''- �• �.
LEGAL
DESGRIP7ION OWNER / dVa'" "J ° °k✓ �"
BLOCK TRACT Y d a^ MAIL -
7 L - ADDRESS i !� z0 —
NO. OF BLDGS,
f Y. is _.
SIZE OF LOT' ° NOW ON LUT ,f° rITY .� s x ° -
.'' ._. - _. r�., iq✓ t.l,=.:'`P F'6 i "TEL.N0.
USE OF '. .
BUILDINGS JR, �-
DISTRICT i
...._..._. _ ICT NO. GROUP �- B K "AAP
�, PG
CONTRACTOR ,t`'6i _ M..-'' ,. f �'- ,
J
ADDRESS d ---- CONNECTION DATA
Cd'YY •,_.� _
TFL. NO. Lr" sem' , �"" E` _ STATION sem- 7/ ed�"f DEPTH
—y
0 STATE � 11A;,1ti E-REFERENCE
REGISTRATION NO., C. . C" '� ❑ COUNTY — ;_ p r UPP R - `LS --
TYPE OF--t ..NNEfF LENGTH FROM
No. DESCRIPTION OF WORK FEE _r' BURR _ C� ^�n9_L.TO P.L � 4� --
(�HOUSE SEWER CONNECTING, TO
PUBLlC SEWER _ _ ___ qi, $ 3,50
�I HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM 1.00 � ------�--
��
CONNECT ADDITIONAL BLDG. OR � �- CO. IMP. . JOB... NONO. ar
64 ORK TO HOUSE SEINER
00 ',.
ALTER OR REPAIR EXISTING
--- --__ - —SS SS•-----Fr•�---_.O�_
'ER OR ill SPOSAL SYS_TEMM_ 1.00 TRUNK PERMIT N0, ROAD PERMIT NO -�
D SCONNc.GT AND AEANP.ON Se.,EY?
1ND`OR DISPOSAL SYSTEM �1 OC STATE ENCROACHMENT
_PERMIT NO.
tEPTtC T'AhK 5EE FGE PYT OR
PI S A,ND OR D'.A1 dFIELD CO' j tNDuaRtAL
-- CESSPOOL DRYWELL �.
51-E i..AL CONDITIONS ONLY 2.00
CHARGES
Ts �.- CONNECTION CHARGE'FEE
OZpl;
'S _ i _ 1 ! GaAUTHORIZATION TOTAL TOTAL FEE�---�— i--��fl REIMBU SEMEvT FEE_
i
-I HAVE. THIS DATE CONTRACTED WITH THE H-ERE'N NAMED CON-
TRACTOR TO CONNECT THE ABOVEDESCRIBED EXISTING DNEL ING 'w
TO THE PUBLIC GEAIER.
SIGNED THIS__ ,i__.._._._DAY OF rd x# A ",V NEW HOUSE SEWER -- — I --
OWNER ORE .,` ,' CONNECT ADDIT 0NAL
OWNERS AGENT -.y BUILD-(NG-OR WORK_--
SEPTIC TANK SEEP. PITS)
pDrl FS� .� 1 x AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE. THAT 1 HAVE READ THIS APPLICATION CESSPOOL[71 DRYWELL L�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COI,APLl'
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS, REPk
SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AA PROPERLY REGISTERED AND/OR
LICENSED AS RE.OUiRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF ThE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY,PROPERTY. BACKFILL SEPTIC TANKS 0
"/, _ STEEP Plf CESSPOOLS 0
SIGNATURE
OF PER M17"TEE
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION a��
r. f e_. l a:r ...
BY BY
DEPUTY -DEPU'T'Y
BY BY
Gl nePYITv �k FPu7Y<
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 1108010001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: ISEWER / SEPTIC: SEWER I BUILDING ADDRESS:
[TR: 5903 IT: 61 UN: .002 1EXIST OCC GRP: 6231 MUSCATEL AV N
IBLDGS. NOW ON LOT: SGAB CA 917752626
(ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET:
15386-009-018 (ORIGINATION: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH: [
ITENANT: MANHOLE REFERENCE: UPPER/LOWER: IISSUED ON: PROCESSED BY:
1 I 108/01/11 SR
I [COUNTY IMPROVEMENT NUMBER:
[OWNER: TEL. NO: [PLAN CHECK NUMBER: IFINAL DATE FINAL BY: CODE: 1
1SU-E & ELAINE TAN (626) 872-4826- IJOB NUMBER: I 1i I
16231 MUSCATEL AV ITRUNK PERMIT NUMBER: 111 [
ISGAB 917752626 IROAD PERMIT NUMBER: IDESCRIPTION OF WORK
[ [AFFADAVIT: NO IREPLACE SEWER LINE
IWAIVER: NO
[APPLICANT: TEL. NO: [EASEMENT: NO [ [
ICHEN, GEORGE (626) 233-7130- 1 [ I
1217 CATOLWOOD DR. IRECORD INSTRUMENT NBR: RECORD DATE: [SPECIAL CONDITIONS:
ARCADIA, CA 91006 [HIGHWAY/STREET WIDENING:
ISTATE ENCROACHMENT PERMIT NUMBER: 1
ICONTRACTOR: TEL. NO: [ FEES PAID [APPROVALS DATE INSPECTOR SIGNATURE 1
ISHIH MANAGEMENT, INC. (626) 451-0763- [ 1 I
19147 OLEMA AVENUE LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER I I [
[TEMPLE CITY, CA 91780 864481 1 1 I [ I
[ 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL I 1 [
I 115 ALT/REP HOUSE SEWER 1.00 EAC 30.40 IBUILDING OR WORK [ 1
[ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1 I I
1 - I ISEPTIC TANK, SEEPAGE PHI I
I
LIC. NO: I (AND/OR DRAIN FIELD I I
I I 1DRYWELL
I I
[ SEWER MAP BOOK: PAGE: I [ALTER, REPAIR, SEWER OR I I I
1 1 SEWAGE DISPOSAL SYSTEM
I � I
1 I IDISCONNECT PLUG AND I 1 [
I I [ABANDON HOUSE SEWER
I I I
[ I IBACKFILL SEPTIC TANKS I I I
I [ ISEEP. PIT _ CESSPOOL
1 I 1GRAYWATER SYSTEM I I I
I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
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