HomeMy Public PortalAbout4869 ROBINHOOD AVE_Sewer__ 7CA64Zr3
'a iY5.1663 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDR55S
JOHN A. LAMBIP, C-CUINTY ENGINEER
CASSATT D, GRIFFIN, SjP T OF BUIL.DiING LOCALITY
Z
NEAREST �Q /
FOR APPLICANT TO FILL IN Ross sr
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL -7
BLOCK TRACT ADDRESS
NO. OF BLVGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE Or STRICT NO. GROUP MAP
I I -
BUILDINGS
DI
8K PG
CONTRACTOR
ADDRESS CONNECTION DAT-X--
STATION DEPTH
CITY
j TEL No,
MANHOLE REFERENCE
STAT E 0 W E
REGISTRATION NO, COUNTY
NO DESSCIRMPTION—'OF WORK FEE
TYPE OF CONNECTIO;i------ LENGTH FROM
HOUSE SEWER CONNECTING 0 Y . c
PUBLIC SEWER @ Y. CURE P.L. M.L.TO PL
SEPTIC TANK,SEEPAGE PIT'OR
PITS AND/OR DRAINFIFLD 3.013
P. C. NO,
EXTN.,CESSPOOL,DRYWE'LL MANHOLE 2..GO 0
—US F�S 11-w—E,w CONNECTING T 0
PRIVATE DISPOSAL SYSTEM. 'fie TRUNK PERMIT NO, ROAD PERMIT NO.
1ADD
. - --'.----- ------1-- STA — -
ONNEC'f ADDITIONAL ELDG.CR �A J�OACHMENT
WORK TO HOUSE SE',VFR (qT $1.00 P E R M I T.14 01
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 'a 1.00 NASTE APPROVAL
CHARGES
—----- CONNECTION J;WRGE FEE
OWNER'S PERMIT 00
REIMS-Uf(SEMENT FEE
AUTHORIZATION TOTAL FEE
I HHEREIN NAMED CON-
AVE AT THIS DATE A CONTRACT WITH THE APPROVALS 1 DATE j1NSPFCTO[CSSIGNA7URF.
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEVIER, NEW HOUSE SEWER
SIGNEDTHIS—I)AY OF CONNECT ADDITIONAL
OWNER OR "T BUILDING OR WORK
OWNERS AGCNT-44"1
SEPTIC TANK,SEEP PITS)
_ADDRESS ANDJOR DRAINF!FIDi_
--.--.----.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATSON CESSPOOLEDRYWELLLI
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
NITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR j
PLUMBING AND SEWERS, —SEWAGE-DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED I"' LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I 1HE LEGAL OWNER OF THE ABOVE —ABA-NDON-HOUSE-- SEWER
DESCRIBED RESIDENTi-AL,?q'OPERTY. LLS EPTIC TANKS t-i
SIGIqAURE SEEP.PIT(S) D CESSPOOLS L3
T —------
05 PERMITTjE
[OHN A. LAMBIE,Cou%'7Y ENGINEER .-VALIDATION ROBERT A. WOOD, CHIEF PLDG. INSPECTOR
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