HomeMy Public PortalAbout4917 ROBINHOOD AVE_Sewer__ :aE-66 APPLICATION FOR PERMIT 1
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DIVISI®N OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING y.
JOHN A. 1_AMBIE, COUN-IY ENGINEER -ADDRESS � 4_�� �i--
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J CAS.;3A,TT iJ. GRIFFIN, Si1P'T OF 6utt,otrac. LOCALITY" J r -. ,, K.-. `?` i l-L• .:
FOR APPLICANT 'TO FILL. IN CROSS sr:
LEGAL
D SCF, PNON LOT NO OWNER f,! . _
BLOCK :;A�_' MAIL / a f >-7
r/
ADDR@oS /%;r ./
NO.OF BLDGS.
SIZE OF LCT NOW ON LOT �5 CI7Y..:. / :�.�; r. .� TEL. NO.
USE OF -
'4 - DISTRICT NO- 1 GROUP BU NGS_ .v_'� - ��. . / O
1 - I MAP
PG
CONTRACTOR
c®Iv-rECTrorr DATA _
ADDRESS ---
---
7 '�-- LEPxY-I
GITY YC_'; .�a y,.. Y s NO. C a - ---- - - - --
l .
MANHOLE REFERENCE
-_ r'�J-STATE
REGISTRATION NO. > -.. � �-� tf COUNTY
No EcSCRiPl10 OF WORK FEC
HOUSE SEWER CONNECTING TO = - TYPE OF CONNECTIO v LENGTH FROM !
.c SO ~} C. Y. CURB P La� --M.L 70 P L,
)_ I
PUBLIC SEWER
� . I ---- --__- �--:--_.-
SEPT]C TANK SEEPAGE PIT OR ---
_ PITO AND/OR DRAHNFIELD 2 $'.CO 1 -----
OVERFLOW SEEPAGE PI RAi'IFIELD ._ __ P C NO.
FX.TN.,'CESSPOOL,DRY4IELL.,MANHOLE $2.00 CO. IP. NO. 08 NO.
HOUSE SELI CONNECTING TO _K _
_PRIVATE DISP05Af.SYSTEM _ Ca% $1.00 tRUNPERMIT NO. ROAD PERMIT NO.! -------__-_--�_._--
CONNECT ADDITIONAL BLDG.OR� ---- -- -- STATE ENCROACHMENT --- ---
WORK TO HOUSE SEWER fit. -
_ $I.UG PERMIT N0:
ALTER,REPA+R OR ABANDON HOUSE - .r--- -UST --
t SEWER OR DISPOSAL SYSTEM (� $i,A4 !! [N`USTRtAL
.-__..—..----_I-__-_- WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
0l7
OWNER'S PERMIT ^ — - - -------------- - -- -
AUTHORIZATIONTOTAL FEE REeM uR E?ENT FEE
L
1 HAVE AT THIS DATE. A CONTR,,CT WITH 'THE HEREIN NAMED CQN- APPROVALS DATE i,"ISPE,:TOR SSIGNATURE
----------- -....-.----j- -- R
TRACTOR TO CONa.ECT. THE: ,A50'JE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEVIER, NEW HOUSE SEWER -
SiGNEU THISEAY OF
-s------ ----,x-- 1�.--- CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT - _._ ----`- �..- ---- --�- ----i ---- �-' --. -----
SEPTICTANK,SEEP,PITi'si
AN_rI/OR__DRAINFiEt-D__ -1I-_----
.._' - -- ---
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
CESSPOOL[j DRYW£I.t.f]
AND SLATE "I'H..r THE MOVE IS CORRECT AND AGREE TO COMPLY ----.. ---_. _.-- =----,-__-,--.�__----------_.__
R'(T.H ALL COUN Y ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
i HLREP,y' CERTIFY THAT I AM PROPERLY REGISTERED AND./OR -----
L CL%$ZD AS RFUU RED B 'S ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR 7.q lT I ",/THE f EGA.L -C,kVNER OF THE ABOVE ABANDON HOUSE SEWER t
Dea;RtBED RESiDt..TtAL P eQLE:;Y. BACKFILL SEPTIC, TANKS
SIGNATURE ,- i SEEP. Pi I( 1 L CESSPO(,I 5
01" ,..RMITTEE
JOHN A. f,_AM131E.CO ;T TY ENGINEER —"IYALIDATION ROSER'T A.WOOD,CHIEF PL$G. INSPE'CTC)R
CK, M. 9 CA;;N ff
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