HomeMy Public PortalAbout4860 ROBINHOOD AVE_Sewer__ r
76 F,ti1}63 15.55
S&E. _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
JOHN A. L1lMBt;=, COUNTY ENGINEER --ADDRESS ,
v C:ASSATT G. GRIFFIN, SUPT OF BUILDING LOCALITY
_
FOR APPLICANT TO FILL IN CROSS sr. y �
LEGAL sG✓ -- — --
DESCRIPTION LOT NO. OWNER +— ,
r MAIL g' ._-_-------
BLOCK ------ TRACT 's!9 ./ ADDRES"S �--'—.7 - ,..„'-:s, ..: . ,sro . ..�, .---_
NO.OF BLDGS. j
SIZE OF LOT Y' =�`" I m, NOW ON LOT CITY, , , 3�,- TEL. NO
USE OF — --- DISTRICT NO. GROUP MAP
--BUILDINGS-- ,91C PG
CONTRACTDjnt.p, s�.". .s. Y ,-• k �- � __
ADDRESS . CONNECTION DATA'—STATION DEPTH
..."- F DEPTH
CITY ® ,-a. _„„, TEL. NO. '11-j
b i...,_ MANHOLE REFERENCE _UPPER
- ` .. ..:r-, ,- STATE
REGISTRATION NO. �_ - .. A[; COUNTY -
NO. DESCRIPTION OF WORK _FEE - - — --- -----_---
HOUSE SEWER CONNECTING TO _ TYPE OF CONNECTION LENGTH FROM
r( ' Y,--_�u CURB P L L TO P.L.
PUBLIC SEWER 5 3.50 ._�-�' -M _---". ---
oEP'TIC TANK,SEEPAGE PITOR
I PITS AND/OR DRAINFIELD (q; $3.O0 I ---- -- _-- --------- --
OVERFLOW SEEPAGE PIT DRAINFIELD .. C NO.
EXTN ,CESSPOOL,DRYWELL,.MA.NHOLE-r' $2,00 L -0. IMP No,_ �. `.' JOB NO.
i HOUSE SEWER CONNECTING TO ; -- - .---- ---
PRIVATE DISPOSAL SYSTEM t2 $1.00 ! TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITiONALBLDG.OR STATE ENCROACHMENT i
WORK TO HOUSE SEWER -C, $1.00 1 i PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE I. � INDUSTRIAL.
j SEWER OR DISPOSAL SYSTEM (4) $1.0_0 ! WASTE APPROVAL
! CHARGES
II _
CONNECTION CHARGE FEE
OWNER'S lPERMIT_ $ --—i�l as -- ---- — —_ -
PE/MGUP E1 --
AUTHORIZATION —TOTAL .1ENT FEE
I HAVE AT 'THIS DATE A CONTRACT WITH THEHEREIN NAMED CON- .APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER -- ! - _------- --
SIGNED THIS DAY OF, S9 CONNECT ADDITIONAL a F
OWNER OR BUILDING OR WORK
OWNERS.AGENT — - SEPTIC TANK,SEEP,PIT(S)
ADDRESS------. AND/OR DRAINFIELD -
I HEREBY ACKNONi LEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLC} DRYWELLf I I.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR If
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OP. ➢ISCDNNEC'['PLUG AMD
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF �!
CALIFORNIA OR THAT I AM THELEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED.RESIDEN. AL PRO R Y, .r, BACKFiLLSEPTIC TANKS[) ! T
SIGNATURE ( � SEEP. PITS} [] CESSPOOLS[�-._.�—.___I
OF PERMITTEE - 'I --------------
_ I
IOHN A. LAMBIF_,COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
CK. M.0.,q CASH
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