HomeMy Public PortalAbout4905 ROBINHOOD AVE_Sewer__ 7CA64213
E-663 it-55 APPLICATION FOR PERMIT .
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING i
JOHN A. LAMBIE, COUNTY ENGINEF-R ADDRESS
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CASSATT L'. GRIFFIN, 5UP'T Of BUILDING LOCALITYFOR APPLICANT TO FILL IN NEAREST
-LEGAL �....', ,. -- .
DESCRIPTION _LOT NO. OWNER- - -
BLOCK TRACT (,; _ - MAIL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
..USF.OF
BUILD[NGS -7 DISTRICT NO. `. GROUP i MAP
K
CONTRACTOR _3 PG
— _ a f z
ADDRESS r `F, y CONNECTION DATA
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CITY �'' �•-. EL. NO -y ' _ STATION ---- - ::-. -DEPTX
MANHOLE REFERENCE „a ✓7
`TATEL ER
REGISTRATION N0. 0 COUNTY
NO. DESCRIPTION OF WORK FEE ---- — -- -- ---... --- —_-
-- TYPE OF CONNECT"i0 r LENGTH FROM
HOUSES EWE CONNECTING TO Y. CURB--- P L _ M L. T'0 P.L. =.--_--
. PUBLIC SEWER. 3_50:1 - - j —. _-- ---
�-SEPTIC TANK,SEEPAGE PIT OR - _-- - i--
PtTS AND/OR DRAINFIELD cr') $.5 00
-- I ------ --- ---_ .. .
OVERFLOW SEEPAGE PIT,DRAINFIELD P C NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.001 _I CO. 1MP. NO. tOB NO. v �Q
HOUSE SEWER CONNECTING TO '
_PRIVATE D1SF65RL SYSTEM Q' $1,00 J TRUNK PERMIT NO. ROAD PERMIT NO.
I CONNECT ADDITIONAL BLDG.OR j STATE ENCROACHMENT
WORK 70 HOUSE SEWER 9 $I.00 I PERMIT N0.
_- ---- - _
ALTER,REPAIR OR ABANDON HOUSE' —._.0 .._-_---
SEWER OR DISPOSAL SYSTEM (�I;. $I,00 I INDUSTRIAL
_-_ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT 1 00 - ------ _-- --�-- _
REIMBURSEMENTFEE
-
AUTHORIZATION TOTAL FEE APPROVALS f
I HAVE AT' THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ I ,_ DATE �INSPECTOP 5SIGN ATT:P.E
- ---------------------- I
TRACTOR TO CONNECT THE ABOVE DE5QRiBED EXISTING DWELLING
TO THE PUBLIC SEWER. ,._.,1 NEW HOUSE SEWER .,.g
SIGNED T}11 .-TbAY..OF �-._.. 1.9 CONNECT ADDITIONAL
OWNER. OP. BUILDINGOR WORK.
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(Si `
+' Atd D;UR ORAINFI£LV �—�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I
CESSPOOL❑ ORI WELLfl
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ i
A'ITH ALL COLNrY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR l—
PLUMrING AND SEWERS. SEWAGE DISPOSAL SYSTEM
} HEREBY CREQU Y THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSE AS REQUIRED BY LOS ANGELES,:Cfl UN7Y AND STATE OF ABANDON HOUSE SEWER _
CALIFORNIA Of! I tAT L AW, THE LE OWNER OF THE ---- ---------
DESCRIBED RESIDENT OPE XTY i BACKFILL SEPTIC TANKS
SIGNATURE VSEEP. PIT(S) —j GE"s5P00LS1]
6F PERMITT££ K _ '' J `'
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION/, _� ROBERT A.WOOL),CHIEF PLBG. INSPECTOR