HomeMy Public PortalAbout4950 ROBINHOOD AVE_Sewer__ rCAE-663 11.35 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL -
Department of County Engineer
County of Los Angeles BUILDING y r
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ADDRESS
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JOHN A. LAMBIE, COUNTY EIve1NEER =�------
�' CASSAITT 0. GRI.rFtN, SUPT OF BUILDING LOCALITY ! 77
FOR APPLICANT TO FILL IN 1 CROSS S
LEGAL
DESCRIPTION L07 N^ ..,::`& -r....-" #." -xi'-- 1 �, OWNER
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BLOCK TRACT ' ''' 1 MAILADDRES
N0.OF BLDG5
SIZE OF LOT- NOW ON LOT CITY 5'' r •rJ'y.� TEL. N0,
USE OF -
BUILDINGS ..,_.rr y ^� DISTRICT NO, GROUP - MAP
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CONTRACTOR y`J /Y
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ADDRESS - r ° --- --- GdN�T {:_ D .
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CITY .e.+.�- TEL N S7ATIO'd + :�:� r DEPTH ��d-`�a
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MANHOLE REFERENCE �jPn
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STATE
REGISTRATION NO.. 7 I _- -j ! LI, COUNTY ---
r o. i DEkPt!P?!ON OF 1 ORK FEE
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-- --------- ----- - - TYPE OF CONNECTION „"' LENGTH FROM
HOUSE SE Y. CURB L.ER CONNECTING TO _ ' L. - M TOPE. d ��
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PUBLIC SEWER @ $3-SO
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` I SEPTIC TANK SEEPAGE PIT-OR
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PITS AND/OR DRAT vFIFLD ti: $3.00
6VERFLOTI SA,NF'IELD P NO
Lk7N.,CES POui.,CRYtiGLL,MAVHOLE Ea- $2_00 CO. IMP. No. -_--JGB N0.
j HOUSE SEWER CONNECTIN:u 10 .-_—..----i--
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PRItiATE DISPOSAL SYSTEM r, s 1.00 i TRUNK PERMIT ALO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER r, a
1.OQ PERM�T NO.
ORAANDON HOUSE`LTER,REPAIR -i' INDUSTRIAL
F AER.OR DISPOSAL SYSTEM _ (u °�1_00 j l.__.—_ WASTE APPROVAL.
CHARGES
--- _-.--..,-_.-_ — _--- CONAd.£CYIOPI CHARGE FEE
OVMEII'S PERMIT — ---- �— - - ----
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REIMBURSEMENT 17EE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS: DATE A CONTRACT WITH THE. HEREIN NAMED CON- _ _,__APPROVALS _ � DATE I1NSPECTOR`SSIGNA7'URE.
TRACTOR TO CONNECT THE AHGV'c DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE:SEWER
SIGNED THIS DAY OE COtdNrGT ADDITIONAL
OWNER OR BUILDING OR WORK —_—
—--- ---------- — -- ---
OWNERS A.GENT�.: •:� —, SEPTIC TANK,SEEP,PITS?
ADDRESS AND/OR DRAINFIELD
1 144EREPY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO CRYWFLLE '
AND STATE...THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEVVERS SEWAGE DISPOSAL SYSTEM
I DISCONNECT HEREBY CERTIFY THAT I Ant PROPERLY REGISTERED AND/OR ECT PLUG AND
LICENSED AS REQUIRED 3Y j.OS A J TELES COUNTY AND STATE. OF
SI
CALIFORNIA OR I+AT 1_��44 THE L��GAI, L'I'MNER OF THE ABOVE ABANDON HOUSE SEWER f I
DESCRIBED REtii DENT;A..L PROPE.R(Y. BACKF111SEPTIC TANKS `v
ED
SIGNATURE `'�„ l)f�� nom; ---- SEEP_ P,,-.,.{Si LDCESSPOOLR--
OF PERMITT
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IOHN A. LAMB]E (; NTY ENGINEER *L,1DATION ROBERT A.WOOD, CfIIEF PL;3G. IINSPEc•'JFE
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