HomeMy Public PortalAbout4855 ROBINHOOD AVE_Sewer__ SE-66 f(sA3 11.55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDS G
DDRJOHN A. I_AME31c. COUNTY ENGINEER --- -- - - -_ —
CASSATT U. GRIFFIN, SUP OF BUILDING LOCALITY- - - -- a
FOR APPLICANT TO FILL IN -NEARROSS sr. -__-
---ST. --
--- - -- - T f LL IN - - - - -
LEGAL OWNER _
DESCRtPT_i.Otd _LOT NG. 1;;. — _ ?-_ - --- - - f - .QI[; r'�'y,"•--'_.__
`SLDCK� TR�C7 �C--' MAIL -
G ADDRESS ---- ------------ —•------
�,,rr / N0.OF BLDGS,
SIZE CF L,,OT 6' '3E'_'-� NOW ON LOT CITY TEL. NO.
US
BUILDINGS DISTRICT NO, GROUP I MAP
PG p
CONTRACTO ____�_ /
a�4d�4 CONNECON DATA --
TI —
ADDRESS ? -- - -- -.-- -
CITY .µ--1 --� ' TEL. N0. JO "{�..�'` STATIONJJ
_ cn
�'4Nk0' REFERENCE v�r`+� �^+ r i1F .
`C,.' - STATE & R
`�
REGISTRATION. NC r 41— [1 COUNTY
^.--- --`-�— -'""}
NO. I DESCRIPTION OF WORK FEE ---- ---_.,__---_-_.-- --.___.
TYPE OF CONNECTIO LENGTH FROM
HOUSE
SEWER CONNECTING TOX. CURB P.L,.; M.L. TO P.L.
PUBLIC SEWER S' $3.50 ,.7 -- --'--
SEPTIC TANK,SEEPAGE PIT OR
I PITS AND/OR DRAINFIELD {{I; 3. ------_. --
------------
.
OVERFLOW SEEPAGE PIT,DRAINFIELD ! P CNO.
EXTN„CESSPOOL,DRYWELL,.MANHOLE Cq $2.00CO. IMP. NO.
--:_-..._—_ _—.."...C;�'~•#6.�_
HOUSE SEWER CONNECTING'To ! �
__.I. PRIVATE DISPOSAL SYSTEM ca,. $1.00 i ! TRUNK PERMIT NO. _ _ ROAD PERMIT NO.
STATE ENCROACHMENT
CONNECT ADDITIONAL BLDG.OR i -----_ _
WORK 74 HOUSE SEYt'ER- ----.._--- (i_$,.i.GO !---
PERMIT NO.
--i_ - -- ----- -------- --------- -------- _....-------------
ALTER.,REPAIR OR ABANDON HOUSE. INDUSTRIAL
—_i SEWER OR UISP_OSAL SYSTEM L I.Go __.-_-- WAST.APPROVAL -
CHARGES
CONNECTION CHARGE.FEE
OWNER'S Pz I�MIT ----_--- ----------`- ------ --
_
--- -- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE � C3
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _—..--__APPROVALS rDATE— +1N. PECTO R L
SSIGN TRE
_ ..
TRACTUR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
NEW HOUSE SEWER %.
SIGNED THIS DAY OF_— 19—__.- CONNECT ADDITIONAL
OWNER OR � }' BUILDING OR WORK_
q � � `-�---
OWNERS AGENI'--_— -,�� ."�a.�L—.- -- SEPT(C TANK,SEEP, PtT(.S) I .- ------ ---
ABDRESS. AND,'OR DRA!NF'iELD
._.__y AND AGREE TO COMPLY `L E --
! HEREBY ACKNOWLEDGE THAT t HAVE READ THIS E ATO ACESSPOOL[] DRYW ELL❑.
.AND STATETHAT THE ABOVE, ?S'CORRECT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDFOR DISCONNEC/ PLUG AND
I - —
UCENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _ABAN_DON HOUSE SEWER `
CALIFORNIA OR THAT I AM 'HE LEGAL OWNER OF THE ABOVE
DESCRIBED RES1DFK1. L PROP T'Y. BA.CKFILL SEPTIC TANKS
SIGNATURE
SEEP,PIT IS Ll CESSPOOLS[]
4V+" -- -------. — __�—_—
OF PERMITTEE r
IOHN A. LAMBIE, COUNTY ENGINEER LIDATION ROBERT A.WOOD,CPHEF PLBG. INSPECTOR
CASK
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7GA842P 11-57APPLICATION FOR PERMIT
COUNTY OF 7
C6808 � i■
LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING — —
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN. Sup'l of Building LOCALITY
FOR APPLI ANT TO FILL IN CROSS ST.
LEGAL I',
DESCRIPTION LOT NO �i6 d
222:Z�.�g ' _OWNER
BLOCK TRACT MAIL
ADDRESS ,------------ -------
NO.OF BLDGS.
SIZE OF LOT - _—_ NOW W ON LOT .CITY - ;PES VMO.
USE OF
-BUCO TRACTOR ^ — DISTRICT N0. GROUP I r MAP
CONTRACTOR ,-!BK I?G,
ADDRESS CONNECTION DATA
CITY W, TEL,NO. STATION ` DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. COUNTY LOWER
No. DESCRIPTION OF WORK FEE �..._
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR
PITS ANG/OR DRAINFIELD @ $3.00 I T. CURB. P.L. M.1.Af0 P.L.
OVERFLOW SEEPAGE PIT: DRAINFIELD 44
EXTN„CES5POOL,DRYWELL,.MANHOLE @ $2,00
HOUSE SEWER CONNECTING TO �P.V N0,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.N0, 8 N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER c $1,00 TRUNK PERMIT NO. OAD PitRMIT NO.
ALTER,REPAIR OR ABANDON HOUSE — -
SEWER OR DISPOSAL SYSTEM @ $1,00 STATE ENCROACHMENT "y
PERMIT NO.
INDUSTRIAL
j TASTE APPROVAL
-CHARGES
OWNER'S PERMIT ? F.;�°� r_ ✓
� � 7 If. �(1O CONNECTION CHARGE FEE
AUTHORIZATIONTOTAL FEE ! REIMBURSEMENT FEE:,,
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. -
TRACTOR TO CONNECT THE ABOVE DUI.CRIBED EXISTING DWELLING APPROVA S DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC Sf-WER. )
; — —
SIGNED 7Hf5 �
, . DA F OO y 9 - NEY HOUSE SEWER -_ -
OWNER OR - �”"""'"'" CONNECT ADDITIONAL i
OWNERS AGENT - -- BLIILDING OR WORK _
DDRESS �'r' >, $, '•�'a�*�"'0.'�"-- "
SEPTIC TANK,SEEP,PIT(5)
AI --�--
AND/OR DRAINFIELD --
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND.AGREE.TO COMPLY CESSPOOL [I DRYWELL[�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AIA THE LEGAL, OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RES?DENTIA!. PROPERTY, BACKFILL SEPTIC TANKS [I ..
_- SEEP, PIT(S) [I CESSPOOLS CI
SIGNATURE --OF PERMITTEE._
5
eE VALIDATION t ROBERT A,,WOOD
CK. M.0. CASH �°�;y,. S[y�EIiViSif�G AFI =N LC 61I{E',ER
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