HomeMy Public PortalAbout6259 MUSCATEL AVE_Sewer__ ,E808 10-63
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU�LDING
ADDRESS 101-LN A. LAMBIE, County Engineer D R
WILLIAM A. JENSEN, Sup't of Building
LOCALITY:
NEAREST
O�
CROSS ST.
FOR APPLICANT TO FILL IN
pEsCpjFrjON LOT NO OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF ELUGS,
5f 7.E 0'- LOT NOW ON LOT – C P TY il,� r TEL. N 0.
USE OrDj,�TR(CT NO. GROUP MAY P OcLssep BY
_
EIU!LDINGS
SK PG
1--7
CONTRACTOR
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ADDRESS CONNECTION DATA
NO. STATIONDEPTH
El STATE:
MANHOLE REFERENCE
_-REGISTRATION NO Q COUNTY
TYPE OFF CONNKCTION LENGTH 1��K.OM
SES 'c-L�ka P.L. M.L.TO
HOU EWER CONNECTING'f, Y�
PUBLICS WER 3S00 0,
f-C�TANK,SEEPAGE PIT OR P.C.NO. 0
CO,IMP. NO.. JOB NO.
AND OR DRAINFIELD slo.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N'6':�
R;VATE DISPOSAL SYSTEM $3.00
0
j CONN E CT ADDITIONAL BLDG,OR AFFIDA RECORD. INSTR. NO DATE
VORK TO HOUSE SEWER @ S
3.00
78WERFLOW t;FEPAGE PIT,IDRA!NFIELD
EX'N,
--El�"Poc)LDRYWELz-..tAANHC)L.E $5.00
HWY,OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOU5E
SEWER OP DISPOSAr-ISTEM
STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 2
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVL ATEA
T THIS DATE A CONTRACT WITH THE HRF!N NAMED CON. REIMBURSEMENT FEE
TRACOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -------
TO THE PUBL�1-asr1w APPROVALS DATE INSPECTOR'S SIGNATURE
-ifS R
SIGNED TI y OF -
OWNER OR HOUSE SEWER
OWNERC AGENT -ir 111�
=7
CONNECT ADDIT1'NAL
BUILDING OR WORK
ADDRESS—- 7--.---
SEPTIC TANK.SEEP,PITi1)
S HEREBY A kWLEOGE THAT I HAVE REAL) THIS APPL AND/OR DRAINFIELD
ANO STATE THAT THC
r- ABOVE IS CORRECT AP40 AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING
PLUMBING
ING AND SEWERS. CESSPOOL El DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAiR,SEWER OR
L 1C FNSrD AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR 'THAT I AM THE LEGAL OWNER OF, AND INTEND TO
E DISCONNECT AND
S DE IN, THE AEOVF�,4,ISCRIBED R5�giDENTIAL PROPERTY. HO PLUG
ABANDON HOUSE SEWER'
SIGNATURE7—
OF PERMITTEL Z6 tzly4-A BACKFILL SEPTIC TANKS 0
PIT(S)
SEEP, CESSPOOLS
VALIDATION- ROBERT A. WOOD
SLIPERVISING MECHANICAL ENGINEER,
CK. M.O� CASH
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