HomeMy Public PortalAbout4938 ROBINHOOD AVE_Sewer__ 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 ',IV, Me
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS �4 et i w A,e �u
7
CAS SATT D. GRIFFIN, SUP"T OF BUILDING
LOCALITY-_�,a;„y �C � ✓ _
_ FOR APPLICANT TO FILL IN CEAREST ROSS ST, Q h
LEGRL-�..----- -- _ j ---
DESCRIPTION LOT NO: y� OWNERf/r�¢ -S la yp _14 Ido S 4
AIL
BLOCK _-- TRACT �y�(.+CyP,. _ADDRESSNO.OF BBLDGS. _
SIiE OF LOT - - NOW ON LOT CITY �➢�� �✓rdt. TEL. NO. ,�{i (fv`
-_ -- �-
USE 6F /J y - DISTRICT N0, I GROUP- I MAP
BUILDINGS a /,Y _ _
CONTRACTOR .- 51K PG
-
ADDRESS __—__---- CONNECTION DATA =�
DEPTH
CITY - .- _ _ TEL ➢NG, -.- MANHOLE REFERENCE
C] STATE __. 'LOWER
REGISTRATION NO. - ❑ COUNTY
NJ DESCRIPTION OF AORK EEx --- ------
I, --- TYPE OF CONNECTION LENGTH FROM
- --
i I HOUSE SEWER CONNECTING TO I _
PUBLIC SEWER $3.SX. CURB P.L. M.L.TO P.L.
_! @ 0 L� --�-- ----- _ '-L --
TPI - Il SEPTIC SEEPAGE PIT OR
TS
_ PITS ANOR DRAIhrIELD_ $3.O
�ty' U_i�_ --------.
OVERFLOW'SEEPAGE PIT,DRAINFiELD I - P. C. NO.
EX7N.,CESSPOOL,DRXWELL,b+AF,'HOLE Gi $4.66.1 CO..IMP. NO. JOB NO,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM_ (x)_$i_00 TRUNK PERMIT NO. ROAD PERMIT NO,
_-ICONNECT ADDITIONAL BLDG.OR. STATE ENCROACHMENT'
WORK 70 HOUSE SEWER _PERMIT_NO.
I. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL --_`------------- --- --_----
SEWER OR DISPOSAL: -SYSTEM G $I,G I WASTE APPROVAL
_- r_---_r.-..----- CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT -- $ t 00 -- ----- — -----
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON—
TRACTOR TO CONNECT THE ABOVE C£:5CR16ED EXISTING DWELLING i
TO THE PUBLIC SEWER. NEW HOUSE SEWER I
SIGNED THISF_- t� CONNECT ADDITIONAL
OWNER OR - BUIL-DING GR.WORK
OW
ONERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS.__-- - ltN1V0R URA!NTIF' U i
I 1-E BY ACKNOWLEDGE THAT
5 I HAVE. AND THIS APPLICATION CESSPOOL � DRYWE L
c is ^
AND TATE TH.,: 1HE T TO COMPLY �.---.J.--._-_I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR � L -
PLLY.BING AND SEWERS, SEWAGE DISPOSAL SYSTEM I j
r -- ---_ _. ----- ----r..-----
] HE4-3Y C R UI THAT I AM PROPERLY REGISTERED ANDORLICE -DISCONNECT PLU AND
CALIFORNIA
r"�S SF.GUIRi.0 .RAMC THE LEGAL OWNER OF THE AABOVE ..ABANDON HOUSE SEWER— ----��---.----
, c
CALIFORNIA OR THAT 1 _
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS F l
SIGNATURE - SEEP.PIT(S) 0 CESSPOOLS^)
OF PEP.MiTTEE�,- _
IOHN A. LAMBIE, COUNTY=LER VALIDATION ROBERT A. WOOD, CHIEF PLE3G. INSPECTOR
Cr:, N.O. CASH -
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