HomeMy Public PortalAbout4872 ROBINHOOD AVE_Sewer__ 7 -663 i i-85
a E•66 _ APPLICATION FOR.. PERMIT7 -
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles - BUILD174G
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF SUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT i+O�-- - - -----�_ `_- .=Q\YNER
---r °- MAIL _
BLOCK TRACT , - _ ADDRESS
°y� ,�N0.OF BLDGS. - CITY TEL. N0:
SITE OF LOT � 1_ 6N L9T - ---
OF
BUILDINGS GROUP! _-- -- DISTRICT N0, GROUP MAP
--_r 1 _
CONTRACTOR .,,• ,,� .''
ADDRESS : -�__ -- ------ - -- -C® ---- I\I DATA __ - .--- ---
NNECTIo
--D _
STATION ' -_ DEPTHCry
_
MANHOLE REFERENCE r-� / r� _ .__ UPPER--
_ 111 vn
REGISTRATION NO ; �!`1 COUNTY --__----
--- --
NO
DESCRIPTION OF WORK FEE - -
-- - --- -- ----- -- TYPE OF CONNECTION ENGTH FROM
j HOUSESE/ER CONNECTING TO Y r r
1_7 UBLiCSEWER --_ @ $3.501 '�+ -----__- CURB----P L_d'`M L_. TOP L_.._.�1✓>~-..
SEPTIC TANK,SEEPAGE F-I T 0R �--��
I PITS AND/OR DRAINFIELD (a7 $3.00
OVERFLOW SEEPAGE PIT DRAINF[ELD -� P C NO,
- , MP NO. !08 NO.
TXTN.,CcSSPOOL,DRYWELL,MANHO.L1 � $2.6+. CO. I
� __- _-_
HOUSE SEWER CONNECTING TO l
PRIVATE DISPOSAL SYSTEM qD $1.00 TRUNK PERMIT NO. - ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
'hCRK TO HOUSE.SEWER (0 $1.00 4 PERMIT N0. _
-----I --.. . --- ..
ALTER.REPAIR OR ABANDON HOUSE 1 -INDUSTRIAL
.-
j SEWER OR DISPOSAL SYSTEM (a $1.0O I - iNDUSTRIAG
__..---- _---- -- _-._. __. ___--II WASTE APPROVAL
CHARGES _ ..
--i-----'. Illi------- .. ..,�
-- _.--- !.___, CONNECTION CHARGE FEE
OWNER'S PERMIT ----
- 'I DO__. REtM6UR5.EMENT F,�S• "`'
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED APPROVALS
CON• _ DATE IINSPECiOR`SSIGN..TUP.E
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r I TO THE PUBLIC SEWER. NEW HOUSE SEWER -_--_{- -_- -- -
SIGNED T}i1S SAY?OF_�z:.,._ i9 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
.2"" _ ------ I-------F--_.-�—
OWNERS AGENT { B
i - ----- SEPTIC TANK,SEEP,PITS)
ADDRESS
AND/ORDRAINFIELD I
1 IIERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O ORYWE.LLC,
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 SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND'OR —
DISCUNNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO.NNfiY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGA '> WNER OF THE ABg YE
1,r^ _ABANDON HOUSE SEINER
DESCRIBED RE5IDENTIAO'OPERZYJ; d' Vii' BACKFILL SEPTIC TANKS[I —I
rr��
SIGNATURE SEEP,PIT C1j S) CESSPOOLS❑
� '� ---- -- --- ..---�I-- --- - -
OF PERMITTEE '
IOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBO. INSPECTOR
CK. m.0. CASH __