HomeMy Public PortalAbout4937 ROBINHOOD AVE_Sewer__ reAsa<o A _ 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. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDINGLOC
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F'OR APPLICANT TO FILL IN a oss sr.
LEGAL - ------ ---- —....-- - � —c—'-------___.._..
DESCRIPTION_ LOT N0 _ 7 OWNER�:;.� :�',,:t-ga •^�
s MAIL
BLOCKTRACT ADDRESS
�" �� l•� . , RDDRESS `� � 'r�,=�(�„f" '-p
NO,OF BLDGS. CITY TEL. T j::4
SIZE OF LOT NOW ON LOT .d
USE OF ---------
_BUILDIN-GS - DISTRICT NO. GROUP MAP
C/ K. P6
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CONTRACTOR
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ADDRESS �� -� ".~ i, t -- �� CONNECTION DATA
CITY � - STATION .. � DEPTH
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---� " - -- ---TEL, N0.' ?!T
- - - MANHOLE REFERENCE
REGISTRATIONNO. , a" ,� Q COUNTYr
NOJ DESCRIPTION OF WORK ----` FEE _ -- - ----
t - — - --.-- TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNE4T'ING TO -..__ - - �"7 3
PUBLIC SEWER (r_$3.501 ,!_.c' Y` CURS ': M.L.TOP,L.
SEPTIC TANK SEEPAGEPIT OR
PATS AN_D/O DRAINF ELD �-_$3,_001 - —_
OVERFLOW SEEPAGE PIT,DRAINFIELDI P. C. NO.
O -
EXTN CESSPO_L,DRYWELL,NA_NH,-)L_E r�. 1
$2,001 CO. IMP, NO. JOB N0,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM __ (a $1.00 I TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT_
YORK TO HOUSE S£64ER 4y` ^i.CP PERMIT NO.
----- - -_.-
ALTER,REPAIR OR ABANDON HOUSEINDUS
SEWFR OR DISPOSAL SYSTEM �s $1.00 WASTE APP
-- __-- _-- , WASTE APPROVAL
- -----
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S ii 00
—'--� -- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �
I HAVE AT THIS TATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR 70 CONNFC'C THE ABOVE 'DESCRIBED tEXISTING D1'VELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
-- ------ ---- �. -_.__...�--.--
StGNeO Tests__—.� A,Y cr___ .- 19_ _. ---- -
CONNECT ADpIY(ON.:4L
OWNER OF. .� -:_1 BUILDING.OP, WORK__--- --_'�--_ -- ---_--_..---_--_ --
OWNERS AL'EN T,._ .
i
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�' "- --'T- '---'-- SEPTIC TANK.SE�EP,-PIT(S)
ADDRESS_.__.__ AND/OR DRAINF'IELp_-_
I HEREBY A +CNCWLEDGE THAT 1 HAVE. READ THIS APPLICATION CESS.POOLn DRYWELL-
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .__. ..._._ __-----..._----I___-----_-.---
WITH ALL COUNTY ORDI14ANC S AND STATE LAViS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM �
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i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR —' --`---`_--
LICENSED F,S REQUIRED AY LOS ANGELES COUNTY AND STATE OF DISCONNECT PJC AND
-CALIFVRNiA OR 1 HAT 1 AAI'.THE LEGAL OWNER OF THE ABOVE - ABANDON HOUSESEWER j
DESCRfSED RESIDENTIAL PMPERTY. .:=i BACKFILL SEPTIC TANKS[}
SIGNATURE } r t cEEP. P cS1 L CESSPOOLS ---.__---
- ---.
OF PERMITTEE, -
IOHN A. LAMBIE, C TY ENGINEER? VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
GA SR
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