HomeMy Public PortalAbout4918 ROBINHOOD AVE_Sewer__ 7&E-6D&
&E-6APPLICATION LICAT'ION FOR PERMIT
- 7
& -it o`$f t-55 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING fir.
JOHN A. LAMISIE, COUNTY ENGINEER -ADDRESS --�Z � a�f✓
CASSATT D, GRIFFIN, SUP T OF SUILDING LOCALITY cl l i-..,
NEAREST
-- FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO, OWNER
MAIL
BLOCK TRACT �, d ��_"--- ---_—T---
NO.OF BLDGS. CITY TEL,NO,
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO, j GROUP MAP
8UlLdINGS
i B P
r
CONTRACTOR _ " >4
CONI�E TION b-9 A -
ADDRESS, �-'�""/_.a...,,.�' J��"�J ��jl- _ 1 .._...- -- --_ -- ---- --- '—
a r9 >
__STATION n ` � _' DEPTH - 62,Ck /' I-PJf'E� 0, 1MANHOLE REFEP.ENCE PER
_ ' + -"STATE �' -"$,t a . d IER=-
REGISTRATION NO COUNTY _
DESCRIPTION OF WORK _FEE____ '- — TYPE OF CONNECTION LENGTHFROMHOUSE SEWER CONNECTING TO Y,
PUBLIC E W E R _ CURB P L. M.L. TO P L.
50 l;
@ 3 3. _ J -- -- - --— --§`---
SEPTIC TANK,SEEPAGE FIT OR -
PITS AND/OR DRAINFIFLDi
OVERFLOW SEEPAGE P17,DRAWIELD i P C. NO.
j EX TN„CESSPOOL,DRYWELL,MlNHO.LE (tl, $2,.00 CO. IMP. NO.
F[OUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM r' $1.00 I TRUNK PERMIT NO. ROAD PERMIT NO, _
CONNCC TADDITIONAL BLDG.OP.
STATE ENCROACHMENT
_ WORK TO FO-USE SEWER, kt $1.00 PERM IT NO. _
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM btu 1.00 _ WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 Oo _ _ __ -- ------.-----__— _
AUTHORIZATION - TOTAL FEE' — y `— REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA`ED CON. APPROVALS I DATE 1INSPECTOR'SSIGNATURE
-.—'. ----- --- -I-- --
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLlC.SEWER. NEW HOUSE SEWER
SIGNED THIS---�___DRY O _— 19 CONNECT ADDITIONAL
OWNER OR ,y^�,./ r` -- BUILDING OR WORK
OWNERS AGENT_ ;_ v- SEPTIC TANK,SEEP,PITS}
ADDR£5S_ AND!OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL D
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND .STATE LAWS REGULATING ALTER O'i ._RFPAIR SEWUJI+
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM _
' HEREBY CERTIFY CHAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ~�
LICENSED AS REQUIRED BY LOS ANGELES_:COUNTY AND STAT OF I
CALIFORNIA OR THAT I AM TN LEG&t OWNER OF' T,HE ,IKOOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT�'7OPEP „�' t` BACKFILL SEPTIC TANKS[]
SIGNATURE , r.� ,v ',/� SEEP.P 7{ 1 +._1 CESSPOOLS[)
OF PERMITTEE �' - 1
I<OHN A. LAMS E.'COUNTY ENGINEER VALIDATION ROBERT A.WOOD.CiiIEF PLUC, INSPECTOR
r
� je
L,