HomeMy Public PortalAbout4854 ROBINHOOD AVE_Sewer__ I5•S5 APPLICATIONiaK-66
tk FO. \ PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcmtnent of County Engineer
County of Los Angeles BUILDING / va
ADDRESS_._ `'�''.._x• -Is—'- `�¢'�^-1 .1w' ^'_`
JOHN A. LAMBIE, COUNTY ENGINEER
d CASSATT D. GRIFFIN SUPT OF BUILMNG LOCALITY -
NEAREST ----------
FOR APPLICANT TO FILL IN ceoss ST._
LEGAL
DESCRIPTION LOT NO, OWNER -
BLOCK 'TRACT
-ADDRESS -
-------- ---- --'------_
_51Z_E_-OFT.OT' NOW ON LOT CITY TEL. NO.
USE OF
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BUILDINGS DISTRICT NO GROUP I MAP
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CONTRACTOR +' r
e coxxECTiox -DATA
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CITY
-_----_- ,,, TEL MANHOLE REFERENCE
.. ❑ STATE ' '� zL '--
REGISTRA710N N0. �,�, >;,� �21 [] COUNTY
No.1 DE5CRiMION OF WORK _ FEE - -- --_1----------- -- ---
i1 HOUSE SEWER CONNECTING TO TYPE OF CONNECTICC I LENGTH FROM �y
PUBLIC $3_50f_SEWER @ Y. CURB P.L M.L,
i TO P.L.
-- - - —
t
I SEPTIC TAN'] SEEPAGE PIT OR '
I PITS AND/OR DRA:INFIELD $3.0J' -- - —. -- - --------
--I---�----OVERFLOW SEEPAGE PIT DRAINFIsLD P. C.NNO.
CO. MP�N0.EXTh CESaPOOL,UPYELL,MANHOLE r $?.00i JOB
-------- --
HOUSE SEVER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM n, _$1.00 L TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR - STATE ENCROACHMENT
WORK TO HOUSE SEWER G" $.LUC � PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
j SEWER OR DISPOSAL SYSTEM - <i_. WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S _ i{ 00 ------- -------------.—._______�.------- -
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA'M�ED CON- -----APPROVALS DATE 1NSPFCTOR SS;GN.ATURE
----.I.--_-_--- --_---. _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS DAY OF 19,_, CONNECT ADDITIONAL
OWNER OR i—•--• � BUILDING OR.`M —
OWNERS AGENT ''� R", ^----- ----- - —'-----
. SEPTIC TANK,SEEP,PITS) -
ADQRES5 AND/OR DRAiNFIELD {{
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL Ll DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT.AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEXERS. SEWAGE DISPOSAL_SYSTEM
. _
-- -----i— ----
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF __
CALIFORNIA OR THAT I ,AM THE LCG AL OWNER OF THE ABOVE —ABANDON HO_USE-- -- — SESEWER - -
DESCRIBED RESIDENTIAL PROP n TY. �"* BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PITS) 0 CESSPOOLS 0
OF PERMITTEE .. ----_.--- ----
I
IOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. IIA,O. CA 5H
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