HomeMy Public PortalAbout4945 ROBINHOOD AVE_Sewer__ 7GA154D
a E-6263!1-515 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAM:81E, COUNTY ENGINEER A qp!�E
CASSATT 0 G-RIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN "
ROSS
ST >r
LEGAL
DESCRIPTIONOWNER
LOT NO.
MAIL
BLOCK TRACT ADDRESS
NO, OF ALDGS,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
-- ----
USE OF
DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS A
S
10N rATI I,' DEATH
CITY t TEL NO. ---- --
MANHOLE REFERENCE
STATE 4
REGISTRATION NO, ❑ COUNTY
NO. J DEESCRIPTION OF WORK FEE
HOI-E -hliCf- TO-- —------ - TYPE OF CONNECTION--- LENGTH FROM
JS SEWER CONNECTING -4 Y. -
PUBLICSEWER @ $3,501 CURB
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00
---i---O'W-EP-.F-L-OW-S-E-E-PA-G-E-PIT,D-RA-1-N-F-I-ELD,
P. C. NO.
EXTN.,CESSP OL,UPYWELI1,0,ANHOLE Ca $2,00 j -*Q. G B 1M.-
HOUSE SEWER CONNECTING TO
__PRIVATE DISPOSAL,SYST EM I.Do TRUNK PERRIT NO, ROAD PERMIT 140.
CONNECT ADDITIONAL BLDG. OR STAMENCROACH'AFNT
WORK TO HOUSE SPNER (c S I,00 PERMIt"
ALTER,REPAIR OR ABANDON HOUSE JNDUST-�.
SEWER OR D1 SPOSAL.Sr5 EM Q i.COI WAST-P APPROVAL
CK-ki G E S
CONNECTION CHARG,&fEE
OWNER'S PERMIT
-v 00
I- —�i-,� R[iMBURSE,*4!NT FEE,
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH T14E HEREIN APPROVALS DATE [%SPEC'OR'S SIGNATURE
- NAMED CON- ---------
TPA:�TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLiC SEWER. NEW HOUSE SEWER
SIGNED THIS---DAY OF CONNECY ADDITIONAL
OWNER OR BUILDING OR WCRK
OWNERS AGENT--V.,
SEPTIC TANK,5EEP,PIT(S)
AND/OR DRAINFIELD
_�DDRFSS—
I 'HEREBY AKNOWLEDGE THAT I HAVE READ ;HIS APPLICATION CES-COLL] DRYWELLI�-J
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W;TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
F HEREBY CERTIFY TIiAT I ANI PROPERLY REGISTERED AND'OR
LIIENSED AS REQUIRED BY LClS ADISCONNECT PLUG AND
NCELES COUNTY AND STATE OF
CALIFORNIA OR THAT I ;,WTHE LEGAL '011JNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL KtIP5PTY. BACKFILL SEPTIC TANKS
I CESSPOOLS 0
SIGNATURE SEEP.PIT(S)
OF PERMITTEE
101iN A. LAMBIE, COUIv(Y ENGINEER VALIDATION ROBERT A. W001D. CHIEF PLBG. INSPECTOR
CASH
7z, 0 A
4 5k) 0