HomeMy Public PortalAbout4902 ROBINHOOD AVE_Sewer__ 76A
E-60�YY-B5 APPLICATION FOR PERMIT
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DIVISION Of BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER aDORESS
v DASSAT�T 0.GRIFFIN, SUP'T.OF BUILDING SS
FOR APPLICANT TO FILL IN NEAREST
S'C,
LEGAL
DESCRIPTION_ LOT NO .. �,.9 - -- — _OWNER
a
MAIL
BLOCK -. TRACT t � '��
.AD.DRESS
NO.OF BLDGS.'3rti
51Z_E OF L07 — -NO'4V ON LOT
CITY , TEL NO.A,
USE OF " � -------
EUILD[NGS DISTRICT NO. CROUP -SAP
BK PG
CONTRACTOR ;
ADDRESS c _� — _CONNECTION DATA — --^—
;.t'iY � y� _STATION DEPTH _ --
_. _TEL.-N r_-d: /sh MANHOLE REFERENCE _ UPPER
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:. STATE ---------.._�- �.—. ,.-LOWER
REGISTRATION 140. _ Q COUNTY
NO, DESCRIPTION OF WORM .FEC
i HOUSE
_.SEWER CONNEr-..- -- c.----..- — --- -- TYPE OF CONNECTION LENGTH FROM
. NGT _ �
I. PUBLlr SEVIER �u $3.50 I I _Y,-_ --CURB P.L_: 1A L,TO P.L.
SEPTIC TANKSEEPAGE PIT OR I j
PITS AND/OR DRAINFi L_D
OVERFLOW SEEPAGE PI:",DRAINFIELD — --� -�— P C. NO.
-__-,
EKTN_ ELL,P�ANHOLE (k $2.00. CO�IPiP Id.O`_ ---.—JOB_NOS-.--- -.
---- .__---r- :.-----
HOUSE SEWER CONNE KING TO
PRIVATE DISPOSAL SYSTEM (t. $I:00 - TRUNK PLRMiT NO. ROAD PERMIT NO.
-I -- - ------ ---- _-
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMEN3.. ___.�-- -----
WORKTOHOUSE SEWER C.� I.:O(> i PERMIT NO. .
ALTER,REPA R OR ABANDON HOUSF.
.S'4 INDUSTRIAL
{ ER O �I DISPOSAL SYSTEM I. WASTE APPRCVAL
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..- -- ---- --- -- ----- ---I---
- I I CHARGES
�----I---_—__ CONNECTION CHARGE FEE
ONEERnPERMIT ----- - -- `
--
_.t I -1- REISISURSEMENT FEE
AUTHORIZATION TOTAL PEE
I HAVE AT THIS DATE A C N1RCI WITHWITHTHE HEREIN NAMED EON- APPROVALS DATE !JNSPEC-,cF1,SSfGNATURE
A
TRC i) 10 C )NN -;7 trig ^s.B�VE L'ESCk�;JED EXISTING DV:FLLING
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[U 'C.� �UULI_"�E4vER. - -- - NE44 HOUSE SEWER
SIGNED THIS a B Y OF - -19. .-- _. -- -- --- ' _--- -- --
-d - CONNECT ADDIT 04AL
ONNER OR ."i Y - UILD NGOR WORK
Gi NERS AGENT--�''_.__.�
--- ---- .F.TIC TANK.,St FP PITiS) �
AUUY{DS`u ...NR DRAIN,tCL.�
-1 h E Y ACkNOWLEDIGE THAT I w Vf R'e16 THIS -PPLICAI'ION FSr 00LL 'DR'WELL ILI ! ---- -
_.ti1 ir{ r .H cS
? JVI' I8 CC;?R..,Ct AND ACF.... TO CC,I PLT
F,H Af.t CO N Y- ORDINAN,'KS AND STAI'E LAWS RF-GJLAT%NG ALTER REPAIR PNEROR j
L:;[^.?;NG .^,. `;e.z_:.5. sf"VAGE J13Y0E^L SYSTEM
TP-AT ! AM PROPERLY REG S FRED AND/ORG S%:GNNEt P�a AND[_.;,Er�S L '.S ( ..Eii) RY LOS AN'
d--_ES i.JUNTY AND STATE OF AP's.ND N H}UAL SEWER i
C:eLIg:)RIw I>1 1.5 ,HAT ! AM THE LEG .L GMiNER U^. THE ,�BCVE --. ---_ - --- -- '---I----`- ---- ______.
OkSCR:3c.D RESiDENT1„6;Pt OPERA r' y RACYFI 1 SEPTI Tin NILS`� �.
S,C:PdA.7URt? '-✓ .. r' il' ` ... li 5).!_, S,ESSPOOLa ------- _----- ----._____.-_--_
OF PERMITI E.
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10HN A. L.A tOB I E,°C OU N PTY' ENGIN'=_£R 'VALIDATION ROBERT A.'WOOD, CHIEF PLE3G. INSPECTOR
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