HomeMy Public PortalAbout4851 ROBINHOOD AVE_Sewer__ amR-663 r��� 71"83 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
}Department of County Engineer
County of Los Angeles BUILDING ,' . ¢
ADDRESS +'j / f�' s`x ..'..
JOHN A. LAtvSE?[E, C'aunlTY ENGINEER --- � �-- -�-�--
ASSA7T D,GPi1FFit*7, SUPT O�DUILAtNc r_OCALITY
yx
NEAREST ` ..
FOR APPLICANT TO FILL IN _CROSS ST.
LEGAL J
7-
DLSCRIPTION OT NO. - - OWNER
I
MAIL
CLOCK TRACT
� r-�+ TEL. NO.
NO OF BLDGS17
tr _
5:Z5 OF LOF _ NOW ON LO: CITY ;�
USE
BUILDIN S ., 1/,� -/ '4f ' >r r -. DISTRICT NO, ! GROUP r' MAP
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CONTRACTOR l � rte¢ti� � t �% f- _ � .t � I `��
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= - — -ADDRESS CONNECTION DATA
'-„��i•'-- �-..—�-•���=—?�- roa'y � { y'� -- --- - -
i ..i, STATION PTH-_ —3.�._�.
ITY l fr TEL NO. if i >' `� ! f - — -
MANHOLE REFERENCE- UPPER
STATEtlY
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REGISTRATION N0, ..; ./ ,.!- [� BOUNTY ..-.--'°'--�`--�
l'O. ! DESCRIPTIvii V� 4JttRK - F es.-.
rI ,_-. Y- _CURB �L r
C -- TYPE OF
_ CONNECTIONLENGTH FROM
M.L. P.L,
L,
1`J '-PUBLIC SEWER
SEWER CONNECTING TO f LENGTH
$ 0.50 ', _ ---' -- ---
-- -�
SEPTIC TANK,SEEPAGE PCT OR P;TS AND/021 DR-A I NF 16 Lf C 3.00 { -----------------...- _ ------------_-.----_-
OVERFLOW SEEPAGE PIT. DRA_NFIELD P. C. N0.
La�N.,CESS509L,LRYVJF I..1_,MANHOLE t. $2.001, ! co_IMP, NO. JOB NO.__a_
HOUSE:SEWER CONNECTING.TO
PRIVATE DISPOSAL SY„TEM. @ -$1.0000 TRUNK PERMIT NO ROAD PERMIT NO.
$1
CONNECTADDITIONAL BLDG-OR -- STAIE ENCROA,_HI,!ENT
WORK TO HOUSE SEINER rt, C-
P�RM1T NO:. _
ALTER,REPAIR OR ABANDON HOUSE --- _------------__--------__._..------_-------_____,.-_--
f W6R Ofi Li5P05A SfSTEIA u INDUSTRIAL
-WASTE APPROVAL
- CHARGES
__-- CONNECTION CHARGE FEE
OWNER'S PERMITTr�– '--- – --- -'--- -- _._
� I GO
-- -s-` REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �T �a
' .NAVE AT 'THIS DATE A CONTRACT WITH TAF:.' HEREIN NAMED'f.O tV•• APPROVALS ._._-.I_--Doi-E l°rSPE CTgR SSi CtNA7.1 E
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
`0 Tk E PUBLIC SEWER. NEW HOUSE SEWER 1 -
SIGt4D iHiS URY 0F Y 19 `' -- - -4- — --
CONNECT ADDITIONAL
OWNER OR _ BUILDING OR WOR.K..-- -. -..,-- _ ----_----- .-
OWNERS AGENT.-14, EPTiC TANK',SEEP, PIT(S)
ADG3ALS5, - 4+ `ANN/OR DRAINFICID
HEREBY AT_ IN LEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL L, DR9WELL.LJ
!
NNO STATE THAT THE. ABOVE IS CORRECT AND AGREE TO COMPLY `._:�_ .._--- -.-.. _-,_ -...I—..-__-�.
W;TH ALL C`UNTY ORDINA14CES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUM III 1:'. ANIT; SEWERS, _-+ $F,WAGE DISPOSAL SYSTEM
HEREBY CER-Ir':` Ti{A7 I .AV,, PROPERLY REGISTERED AND/OR - --LUG AND � --r--'-
LICENSED AS li 4-, B+ I .- E`.E3•:.CO3a,PSr'Y AND STATE. OF DISCONNECT PLUG AND
CALIFORNIA. OR i i-'T I ZM THE LL.;laL ?-0 vI E,R OF THE. .k E?p.VE ABANDON HOUSE SEWER I {
DESCRIBFD Rt-;`- �.fAl,'?'}C rLt(TY. !- ,+,' BACKFILL SEPTIC TANKS[I --I I` —`-----
S?GA4T Jf E + C SEEP.PIT(S) L (.ES_'OOLa L3.�___---- — _ --
y '3 i / -- -- --------
OF' URE
IOt- N A. LAMBIE, Co,gN-rY E-,,GINEER LIDATION ROBEIR"C A. WOOD,CHIEF PLEIG. INSPECTOR
CAST{
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7681_57. APPLICATION FOR PERMIT 1
�1
�>:e08I
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
7jEPARTMENT OF COUNTY ENGINEER.
BUILDING AND SAFETY DIVISION BUILDING �—
JOHN A. LAMBIE, County Engineer ADDRESS � -� � � � t.'(
CASSATT D. GRIFFIN. Sup't of Building @r
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. y�
LEGAL
DESCRIPTION LOT NO �,- ?'' e'D 7 _OWNER
i
SLACK TRACT :fy MAIL
ADDRE4i
0.OF BLDGS. {
SIZE OF LOT ,aNOW ON LOT CITY * ✓_.. '
TEL.NO. P'• � .
USE OF
BUILDINGS DISTRICT N0. GROUP MAP
CONTRACTOR - ' BK„ PC,r'
ADDRESS CONNECTION DATA _
CITY TEL.NO, STATION ,�p.-. ��.rj DEPTH
CI STATE MANHOLE,REFERENCE UPPER
REGISTRATION NQ. ❑ COUNTY LOWER
NO. + DESCRIPTION OF WORK FEE
HOUSE SEWER-CONNECTING T0�
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE P17 OR TYPE OF CONNECTION LENGTH FROM
Y. CURB P.1, M,L.TO P.L.
PITS ANO/OR DRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN_CESSPOOL,ORYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO I P C NO
PRIVATE DISPOSAL SYSTEM Q $1.00 CO. IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
7 WORK TO HOUSE SEVER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 0 $1.00 STATE ENCROACHMENT
"'— PERMIT NO.
�. INDUSTRIAL..
WASTE APPROVAL
CHARGES
OWNER'S PERMIT — _— —
1 00 CONNECTION CHARGE FEES
AUTHORIZATION TOTAL FEE +REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAL DATE _�INSPECTOR.'SSIGNATURE,
TO THE PUBLIC SEWER. ----
SiGNED THIS_ DAY OF _1 gNEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADOPESS SEPTIC TANK,SEEP,PIT(S) -
-- - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -- -- --- -- ------� --
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY" CESSPOOL F-1 DRYWELL{-1
WITH ALL COUNTY ORDINANCES AND STAT'& LAWS REGULATING ALTER,REPAIR,SEWER OR i
PLUMBING AND SEWERS. ALTER, DISPOSAL SEWER
M II`
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR --DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER_
CALIFORNIA OR THAT I AM THE LEGAL, OWNER OF THE ABOVE -
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT_(S) ❑CESSPOOLS ❑
OF PERMITTEE
�r V'ALIDATI®NaF OafVT". WOOD
r a•o• s. SUPJ.j:R1tISING MECHANICAL.ENGINEER