HomeMy Public PortalAbout4930 ROBINHOOD AVE_Sewer__ t�—
��A84ar APPLICATION FOR PERMIT 1
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• DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. L AMBLE, COUNTY ENGINEER ADDREss
J CAS.S'ATT D. GRIFFIN, SUPT OF BUILDING LOCALITY F+1 f
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- FOR APPLICANT TO FILL IN NEAREST.
- .'
.LEGAL - .
DESCRIPTION LOT NO.-: T �, OWNER/,
BLOCK TRACT el MAIL
ADDRESS
NO.OF BLDGS,
SIZE OF L07 NOW ON LOT CITY TEL. NO.
ll5E OF .._-- - "- — -- _- _--- -----
Ufta NfS DISTRICT NO. I GROUP i MAP
HxK PG
L1 „-�
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CONTRACTOR c ov,f
ADD REss e` _ _ CONNECTION DATA
""."..�.� f. ATION '.� �z�'.r .'. eePTH
Z"TYt� MANHOLE REFERENCE _ UPPER
—5- `—TATE
REGISTRATION NO. L am. [I COUNTY
NO,_�- DESCRIPTION OF WORK. TEE —TYPE OF C014NECT10N LENGTH FROM 4,�'� --
ROUSE SEWER CONNECTING TO ^— --' I -T Y, CURB 4' L `' M,L. TO P.L.
PUBLIC SEWER@ "w 3.50 -- L..fT ,_ ---- — -- --- — - .�-- -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/UP DRAINFIELD Ali; $3.00 --.-
1 OVERFLOW EE
SPAGE PIT DRAINFIELD P C NO , 4 "5
EY N_,CES SPOOL,DRYWELL,MANHOLE C' $2.00I CO. IMP N0. JOB NO
HOUSE SEWER CONNECTING TO
--_ PRIVATE DISPOSAL SYSTEM tr S 1.00 TRUNK PERMIT NO ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (a; $1.00 ! PERMIT NO,
ALTEREPAIR OR ABANDON HOUSE I
R,
INDUSTRIALS -
I_.SEWER OR DISPOSAL SYSTEM_ _ {r� ^1.00 _ WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $- - — t oo
--- -- — --- — - --
AUTHORIZATION TOTAL FEE --._I REIMBURSEMENT FEE
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I HAVE AT THIS DATE A CONTRACT WITH..THE HEREIN NAMED CON- �_-APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESC IBED EXISTING DWELLING
'0 NiE PUBLIC SEWER. - NEW HOUSE SEWER ----- - ..
SIGNED THIS � '" -- —_-�
Y OF � __.�_.--1�5_..� CONNECT ADDITIONAL
OWNER OR ,� � F ` BUILDING OR WORK
- -
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
r _ i AND/OR AAD DRAINFIELD HEREBY yACKNDWLFDCE THAT I HAVE READ IY -----.._ --.-------_-- _ _-----_-----�--
c t _
THIS APPLICATION CESSPOOLD DRYW'ELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR � -----
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STA'>:" OF D35CONNECTPLUG AND
.j ABANDON HOUSE SEWER _
:CALIFORNIA Oil THAT I-_AM TT LEGAL. ,01AINER OF THE rOVE ----- ---- ---- -
DESCRiSED RESIDENT OPE 4 BACKFiLLSEPTIC TANKS C
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SIGNATURE SEEP.PIT(S) C CESSPOOLS(--, _ —
.�sf, r '` — ----- --- I
OF F£RMI7TEE
IOHN A.LA,MBIE.COUNTY ENGINEER VALIDATION ,;r..'_ROBEIZT A. WOOS, CHIEF 'LEG, 1NSPFC:TOR
CASH
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