HomeMy Public PortalAbout4875 ROBINHOOD AVE_Sewer__ 3&1*E•06d2963 i)•55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Loa Angeles BUILDING 7,
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF-'SUILDING
LOCM ITYNEAREST r
FOR APPLICANT TO FILL IN GRoss Sr
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LEGAL r f -
_DESCRIPTION _ LOT N0. OWNER— - SSSS
BLOCK _ TR ACT e',.�.-• _.MAIL i—
✓ ADDRESS
F BLDGS., -`---- -- CITY TEL: N0.
SiZE_OF LOQ ON L07 ---.--_—_-
USE OF
_BU(I.DIN_ .- '' _ Y_ DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
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-- CONNECTION DATA
ADDRESS
Cf`�,,7_..,✓y'`` ��P- � - 0 - --JCL _ AN_ - .�' --- DEPTH
MANHOLE
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�' �'---- ANHOLE REFERENCE. i � _UPPER
G--STATE --- -.—, d✓° ; tea. .--..-LwWi -
REGISTRATION N0. Ell COUNTY
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NO. i DES CRI It?N OF WORK FEE
HOUSE SEWER CONNECTINS'70 TYPE OF CONNECTION ,EgGTH FROM r'
T_ I PUBLIC SEWER _- —--_ @ ?._gp K Y,—�_ CURB P.L. M.L. TO P.L. ___---
SEPTIC TANK,SEE-PAGE PIT OR
I PITS AND/OR DRAINFIELD (« $
_ - MMMT----I--- 1----...
{ OVERFLOW SEEPAGE PIT, DRAINFIELD 1 F. C. N0. �� 7
EXTN ,CESSPOOL,DRYWELL,MANHOLE fa $2.00 CO. IMP..NO. JOB NO.
_
HOUSE SEWER CONNECTING TO T— � ��,. ✓
_t PRIVATE DISPOSAL SYSTEM (u $1.00 TRUNK PERMIT NO _. R AD PERMIT:NO.
CONNECT ADDITIONAL BLDG.OR -
_..---..
OK TO HOUSE � STATE ENCROACHMENT
W__RSE SEWER_ _ $I..00 l — ^j _PERMIT NO. ..4
ALTER,REPAIR OR ABANDON HOUSE R OINDUSTRIAL --�'f _— —_ --------�--
-- SEWER DISPOSAL SYSTE 6I IVa $1.00 !SSSS WASTE APPi 4Q*kC
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_ _ CONNECTION CHARGE FEE _
OWNER'S PERMIT 1 Igo --- --
—SSSS—�
_
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE � _dao APPROVALS � DATE INSPECT R SSf GP�ATURE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE .ABOVE DESCRIBED EXISTING Uth`ELLING �+ I
TO THE PUBLIC SEWER, 6.--L_ NEW HOUSE SEWER
SIGNED THIS. —,,,' D'AY 9'F -19_—. CONNECTADDITIONAL
OWNER OR r- ' ` BUILDING OR WORK I
OWNERS. AGENT .+�� --------
�.. SEPTIC TANK,SEEP,PITS)
ADDRESS-- AND/OR DRAINFIESLD
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—
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL L] DRYWELL JW
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AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH AIL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR�
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ----�--- ---I- -'-'t"'—'�— - ----"`--
LYCENaED AS REQU?RED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 M^y TH:. LEGAL V ER OF THE ABOVE —ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIA{,, RO,PERTY.. .�' �' - BACKFILL SEPTIC TANKS 0 P� I
'SIGNATURE r' y+`6� SEEP.PIT(S) 17 CESSPOOLS Ll
OF FERMITT€E --i'� -- --- - -- --- - -
1
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD.CHIEF PLBG. INSPECTOR
CK, N. U. CASH