HomeMy Public PortalAbout4931 ROBINHOOD AVE_Sewer__ SAG420 it.55
E-66APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depmt;;nent of County Engineer
County of Los Angeles BUILDING
-ADDRESS �
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JOHN A. LAMBIE, COUNTY ENGINEER J
CASSATT D.GRIFFIN, SUPT OF BUILDJNG ,y �+
LOCALITY ,r-I 1>��,.NEAREST /
7�GA OR .APPLICANT TO FILL IN CROSSSTSz 1w
_LOT NO.`.- _ -- –r,WNRMAIL
TRACT /'!f — _--_ _A DRES_NO S�
SIZE OF LOT NOWOONBLOTS —CITY Y'1� �d 's TEL.
.USE OF !. DISTRICT NO. .I GROUP MAP
BUILDINGS - -
-- — '---- --- - ------ --
6K PG
CONTRACTOR -
_ CONNECTION DATA
ADDRESS - ------- ---- ----
-----.—_-- -. ----' --- Si'ATION DEPTH ..
CITY TEL. NO. -
------ .-- - MANHOLE REFERENCE - _ UPPER
❑ STATE _.—.. -r f r. �•..�LOYJ_2
REGISTRATION NO. ❑ COUNTY ---- '�
NO. 1 DESCRIPTION OF WORK FEE - -- ---- - -
------ --- TYPE OF CONNECTION, LENGTH FROM
HOUSE SEWER CONNECTING TO -f Y. CURBP.L.` M.'6,TO P.L.
PUBLIC SEWER _ _ _ @ $•3.50 --- - -- - --
SEPTIC TANK SEEPAGE PIT OR I —�_— ----- ----_"--` --
PITS_AND/OR_DR_AINF_IE.LD _ Cz. $3.,00
--.I-OVERFLOW SEEPAGE PIT,DRAINFIELD --�_-- _ P. C. N0.
EXTN CESSPOOL-,DRYW ELL,MANHOL_E ((7L $2.00 I — --CO. IMP,_NO.
j HOUSE�SEWER CONNECTING TO _ - -
PRIVATE;DISPOSAL SYSTEM - c $1.00 �— TRUNK PERMIT NO. ROAD PERMIT NO.
j CONNECT ADDITIONAL BLDG.OR ! STATE ENCROACHMENT
WORK TO HOUSE SEINER $--I.GD - PERMIT NO. -
._. '---- ----AAAI.--- _ ->.------ --.._-----'-------'--.
ALTER,REPAIR OR ABANDON HOUSE I INDUSTRIAL
I SEWER OR DISPOSAL SYSTEM - o $1.00 —__ WASTE APPROVAL.
CHARGES -
I
CONNECTION CHARGE FEE -
OWNER'S � PERMIT �. $ 1 11 00 -
----- ---- ---- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE APPROVALS y� e
VALS DATE INSPECTGR'SSIGNATURE
I HAVE AT THIS DA?c A CONTRACT WITH THE HEREIN NAMED APPRO
CON• ---__- .-_.-----_-- ---�---- _l.. ._-- -.-----,.__.-----
TRACTOR TO CON FCT THE ABOVE DESCRIBED EXISTING DWELLING I..
TO THE PUBLIC �ER. NEW HOUSE.SEVER
SIGNED THfS_ D O — --- –
---;� ---i. 'Ig ONNECT ADI710NAL
0 ]NER OR _ _ BUILDIN OR WORK
OlVNERS AGENT_: -- SEPTIC TANK,SEEP,PIT($) 1
N[,/ k f1RG.INFIELD !
- --- ---
I HEREBY ACKNOWLEDGE THAI' I HAVE READ THS APPL CATION -
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY E=.'POGL� G4Yk ELLS
WITH ALL COUNTY Y ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR SEWER OR , �✓
PLUMRING AND 3rlt ERS. Sz:.W;,-CE DISP05PL SYSTEM ! I ^-
..-
i H I;Eif :.ER1-f}' THAI I AM PROPERLY REGISTERED AND/OR 1
L;C£NSLD AS RFuUIR-D BY LOS ANGEL ES -OUNTY AND STATE OF OiSCU�NECT PLIC AND i
,HE LEGAL. OWNER OF THE ABOVE AEANi,OfI HOUSE SEW ER ----��--,--------------
CALIFORNIA OR THAT L AM T A - --- -----
DESCRIBFD Ri-S DE 'T;^, PROPERT-(. 7,ACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIf.S. Lj CESSPO---- ---I .j
OL. O
OF PERMITTEE - - -
JOHN A. LAMBIE,COUNTY ENGINEERVALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
CASH
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1' 4535c Ls ;S .+''21 4 445 }
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