HomeMy Public PortalAbout4912 ROBINHOOD AVE_Sewer__ 76A5�62D APPLICATION FOR PERMIT l
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING U I L D I G
JOHN A. i_AMBIE. COUNTY ENGINEER -B---- #-� - -
� C.45S.ATT D. GRIFFIN, SUPT OF EiUILDIh+:Ci LOCALITY
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-- NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. _— --" - .--- — OWNER , &-: t A----.----
i MAIL
BLOCK TRACT --�•+�
,y r _ADDRESS
NO. OF BLDGS, CITY TEL. N0.
SIZE OF LOT - NOW ON LOT
USE
BUILDINGS DISTRICT NO, GROUP MAP
_ _
CONTRACTOR }'
Vr >� - $ r._ ' e"y
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- ---- —JCONNECT16N DATA
ADDRESS
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STATION - L I/- — " DEPTH - --
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N0. �f' ------ MANHOLE REFERENCE
.c.-...c..F-- .-.gT:aKTELOWER_
REGISTRATION NO. COUNTY
NO. [ DESCRIPTION OF WORK FEE TYPEOF CUNNEC7IGN�-� LENGTH FROM
HOUSE SEWER CONNECTING TO Y. _ CURB yf P L^;� M.L.70 P.L.
-� PUBLIC SEWER @ $ 3.50. t ,----�-- ---
SEPTIC TANK. SEEPAGE PIT OR
PITS AND/OR DRAINF E.LD 4t. $3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD
P C. N0.
f EKTN.,CESSPOOL,DRtWELL,M»NHOL.E $2.00( CO, IMP N0. 106 NO. 1
HOUSE SEWER CONNECTING. TO
PRIVATE DISPOSAL SYSTEM —(y $7.00 ' TRUNK PERMIT NO ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.Oft -_ --- - -_---
—WORK TO HOUSE SEWER, et $1.00 STATE ENCROACHMENT
---- -- -----_ ._._------ - -- --- _PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Cr $1.00 _ WASTE APPROVAL
CHARGES
—.---_ _—., `---
CONNECTION CHARGE FEE
OW'NER'S PERMIT - _._ - - ------
AUTHORIZATION TOTAL—FEE----------..---
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I- DATE (INSPECTOR SSIGN.ATUR£...
TRACTOR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER I'
SIGNED THIS DAY
p 19----- CONNE T ADDITIONAL
OWNER OR BUILDING ORWORK
OWNERS AGENT' -
- -- SEPTIC TANK,SEEP,PIT(S)
ADDRESS- AND/OR DRAINFIELD 4
I HEREBY ACKNOWLEDGE THAT' 1 HAVE READ THIS APPLICATION CESSPOOLO D.RiWELLO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ -----iil
rITH ALL COUNTY ORDINANE� AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I ',M PROPERLY REGISTERED AND'/OR
LICENSED AS REQUIRED BY LO5 ANGELES C0aUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEG �6WNER OF THE NEOVE _ABANDON HOUSE SEWER _ -
DESCRIBED RESIDENT 'C-jPR0PEIy`t�'f BACKFILL SEPTIC TANKS I�`
SIGHATUR.E /v SEEP.SEEP•PII(S)-L] CESSPOOLS(]-�-- ----,----_—_..—_
OF PERMITTEE - ✓' � '' }
IOHN A. LAMBIE.COUN*ENGINEER VALIDATIONROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
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