HomeMy Public PortalAbout4944 ROBINHOOD AVE_Sewer__ 7GAF-66 s.�s
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.APPLICATION FOR PERMITI
&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS I
JC)H:^i A. L_AIVIBIE, CbUNTY ENGINEbR CASSATT C). GRIFFIN, SUPT OF SUiLDING LOCALITYFOR APPLICANT TO FILL IN dosssi.LEGAL
ESRDPTION LOT NO. MAILyTRACT ADDRESS /;-/-NO. OF BLDGS ��
SIZE_OF LOT NOW ON LOT CITY if ," iEL. NO
USE OF — - _ _
-BUILDINGS = DISTRICT NO. CROUP MAP
CONTRACTORADDRESS ✓ _ - -
CONNECTION DATA —
STATION G E rT FI
CITY y� YEL.NO.,,,1'j"`/,,{}• a - - -------'-- - - - --
- _7E !_--'---''t----9'•.4_ `�` °:C-- '1 V-----
MiNHOLE.REFERENCE _. - ,fi?�.
SATE
REGISTRATION i- - ❑ COUNTY -..�.-------~- - -- -----�--- — -
N0. DESCRIPTION OF
--� _ _.-... -- - --- -- TYPE OF CONNECTION LENGTH FROM
HOSEWERUSE CONNECTING TO Y. CURB. P M ? TOP L
I• PUBLIC SEiVER f¢: $ 3.5��__ -- -- -"—' : - --.'_.._.- ----`'----
SEPTIC TANK SEEPAGE PIT OR j
_� PITS AND/OR DRAINF ELD $3.00
OVERFLOW SEEPAGE PIT.DRAINF'iELD P C NO.
EYTN.,CE ..POOL.pKYWELL,AIA NHOti=
LE . $2.00j CO,. IMP, N0, JOB NO,
HOUSE USF.5k!LR CONNECTING rO--- I -
_; ♦•c?IS"ATE DISPOSAL SVSTF.!4t @ $7.00 I TRUNK PERMIT NO. ROAD PERMIT NO.
ATE --_-. -
CONNECT ADDITIONAL BLDG.OR ..------- ---- -- -.....
WORK TO 14OUSE SEWER Car, $I.0D � � SLATE ENCROACHMENT
RMIT No ,
ALTER,REPAIR OR ABANDON HOUSE I --- ---
SEWER OR DISPOSAL SYSTFINI to $I'D) I I'vDU5TR1.4L -
_-- -_..— WASTE AN
j s CHARGE'S
CONNECTION CHARGE: FEE
OWNER'S PERMIT
AUTHORIZATION
11 -0
O
TOTAL FEE --- - -- REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACTWITH THE .HEREIN NAMED CON- APPROVALS DATE (INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING' � t
-- -
7O THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNET)T HIS DAY,GE I9__.__ CONNECT _ _---
—*-�-� , C.,NP ECi ADDIT OVAL
OWNER OR BU7 Lt,1NG 6:?WORK,
OWNERS AGENT __-'-----`----'-
fi SEPTIC sTaNN,SEE?,PIT(S) I
ADCRES5___, .— -_ —_. AND/OR DRA[NNEELD
YE R Fs't .4CKtiGJ:LE GG THAT I HAVE READ THIS APPLiCAT-ON j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPGGL❑ DltYvYEL+Ll ,
WiTH ALL COUNTY ORDINANCES AND STATE. LAWS RECULATING ALTER,REPAIR,SEWER OR ----I -----'
PLUMBING t C AN SEWERSSEWAGE DISPOSAL SYSTEM
I
HEREBY CERTIFY TRA` I AM PROPyI�RLY REC STERED AND/OR DSSCONN£CTPLUC AND
LICE ED AS U KEU 8Y,LOS .�T CEi.'E..{ C" 'f:TY AND SftilE. OF
CALIFCRN A OR i.HAT TH f ABANDON HOUSE SEWER
AM THE1.06A G.4,C. CJ1 F'NT Cb THE, ABOVE
DESCRIBED c IC NTiAa'�''R OPER Y '--_--'-- -
k J .n BACKF LL SEPTIC TANKS
A SEEPo1T(Si L� CESSPOOLS
SIGNATURE ,� .. ---- --
OF PERM(F1'EE 6o,.y j -
JOHN A.'>='KMBIL. COUNTY ENGINEER VALIDATION i"�OBER'F A. WOOL, CHIEF PLB;G. IN"SFECTOR
CK. M.0 CASH
x. 69 26 4 4.51)