HomeMy Public PortalAbout4909 ROBINHOOD AVE_Sewer__ :SA ,
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11-55 APPLICATION FOR PERMIT 1.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angelea BUILDING
UI L D I�N G
JOHN A. LAMBIE, COUNTY ENGINEER
E) CASSATT L). GRIFFIN, SUP-'r OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS-ST.
ST.
LEGAL
DE CRIPTION LOT NO. OWNER '_7
MAIL
""v
BLOCK TRACT DR
AR_
NO. OF BLDGS. y
SIZE OF LOT NOW ON LOT CITY: TEL. NO,
USE OF
B_UfLDtNGS DISTRICT NO- CROUP I MAP
PG
CONTRACTOR
ADDRESS Z CONNECTION DATA
DEPTH
CITY S!A_T!ON
N�
LOWER
A�_
STATE
'U'ry
MANHOLE REFERENCE
;> J_
REGISTRATION NO. COUNTY
El
DEESCRIPTIO40F WORK FEE —------
TYPE OF CONNECTION LENGTH FROM J,
HOUSE SEWER CONNFCTiVG TO Y, cu elp L i'
M,L, TO P.L.
-PUBLIC SOVER $25
SEPTIC TANK,SEEPAGE PIT OR
?ITS AND/OR LRAINFIELD fD $3-00
OVERFLOW SEEPAGE PIT,DRAINFiELD F'. C. NO,
EXTN.,CESSPODL,DPYVELL,MAN40LE 2.001 CG. IMP. NO,
HOUSE SEWER CONNECTIN'G'TO
TRUNK PERMIT NO, ROAD PERMIT NO.
1 PRIVATE DISPOSAL SYSTEM k"g, $1.00
CONNECT
ONNN,
ECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1.00 I
PERMIT NO.
TA-mm-REPAIR OR —HO—USE -R-I AL
SEWER OR DISPOSAL SYSTEM 1�00
WASTE APPROVAL
CHARGES
CONNECTIOX CHARGE FEE
OWNER'S PERMIT CO-
REIMBURSEMENT FEE
AUTHORIZATION TOTAL__--F'—EE—___F7_3_1 ,;.�
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I DATE I N S P E C T 0 P'S S I G N,T U R E
TRACTO RCONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PL�BIJC SEWER,
NEW HOUSE SEWER
SIGNED THIS DAYCONNECT ADDITIONAL,
OWNER OR- BUILDING OR WORK
OWGE
OWNERS A ......
,
SEPTIC TANK,SEEP,A1715)
ADDRESS __ AND/OR DR-AINrl_r_LD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
CESSPOOL
ANC STACOMPLY
TE THAT THE ABOVE IS CORRECT AND AGREE TO O DRYWELLEJ
—
WITH ALL COUNTY ORDINANCES AND STATE LAWS PIEGULATING
ALTER,REPAIR,SEWER OR
PLUMOINC AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANY)/OR
�'I R E D DISCONNECT PLUG AND
LICENSED AS REQ I�X LOS AN�FLES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT j'/AM THE LECAb, OWNER OF THE, ABOVE
DESCRIBED RESIDEN Tl&t PROPYRTY. BACKFILL SEPTIC TANKS
SN'NATURE i SEEP_PIT(Sl Ll CESSPOOLS
OF PERMITJ
e
10HN A. LAMBIE, C6&NTY�ENGINEER
ID TION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. LI. 0 CASH