HomeMy Public PortalAbout4925 ROBINHOOD AVE_Sewer__ 76A6420
5 a S-ec.3 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY -SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGILNEEIR ADDRESSm
NG
CASSATT 1). GRIFFIN, SUPE Or BUILDING Mj LOCALITYItiEAREST /2
FOR APPLICANT TO FILL IN CROSS ST,
LEGAL SA
DESCRIPTION LOT NO,
,-
BLOCK TRACT MAI OWNER
NO.OF BLDGS. CITY TEL, NO.
SIVE OF LOT NOW ON LOT
USE OF I
BUILDINGSDISTRICT NO. GROUP i -MAP
B PG
CONTRACTOR
— CONNECTION
ADDRESS
Tf-ji F0. ATl _STATION
CIT ---- ----
DEPTH
"STATE
MANHOLE REFERENCE _ UPPER
D"P In R
L4
_REIISTRAT1LN N COUNTY 47—
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURBjP.L M.L. TO P.L.
PUBLIC SEWER $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3.00
4,
OVERFLOWSEEPAGE PIT,DRAINFIELD P C. NO
EXTN.,C ESS FOOL,DRYW E LL,10 A NIHOLE Cq) $2.00 lh�PNO,— JOB NO.
HOUSE SEWER CONNFCTING TO
PRIVATE DISPOSAL SYSTEM Cr; $I,00 T-
TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR I STATE ENCROACHMENT
WORK TO HOUSE SEWER .
-,REPOANDO_N HOUSE___ $1.00-i PERMIT NO
ALTER,REPAIR - -
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1.00 WASTE APPROVAL
C14ARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
AUTHORIZATION TOTAL FEE EREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE lNSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,
NEW HOUSE SEWER
y'
SIGNED THIS---,-' DAY CONNECT ADDITIONAL
OWNER, OF? BUILDING OR WORK
0
WNERS AGENTZ
SEPTIC TANK,SEEP,PIT(5)
ADDRESS-- AND/OR DRAIN FI E,LD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[] DRYWELLE]
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWER$, ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE D-ISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I 'M THE LEGUOWNER OF THE—ABOVE ABANDON HOUSE SEWER
-
DESCRIBED RESIDENTIALtAPEF, BACKFILL SEPTIC TANKS El
s
SIGNATURE m!.p IT(S) E CESSPOOL$
-
OF PERMITTEE
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION--,-, ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
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