HomeMy Public PortalAbout4951 ROBINHOOD AVE_Sewer__ :9808 11-37 APPLICATION FO 9 ! PERMIT
1
E800 15
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
g ADDRESS
CASSAATT�D. GRIFFIN Supt of Building i
LOCALITY
[NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER —
BLOCK .TRACT -�-,/ MAIL
�! - y ADDRESS _ - r :-: 1 f yr-`?r
NO,.01 GS^ 5
SIZE OF LOT NOW ON LOT CITY -j TEL.NO,
USE OF
>- DISTRICT NO,
----.— ,.��. GROUP I MAP
CONTRACTOR i 14 h BK PG
ADDRESS ; CONNECTION DATA——�—
CITY TEL,NO. ; STATION j-i y .{J DEPTH ILI �
- STATE MANHOLE REFERENCE '{ ,Y;- f-, UPPER
REGISTRATION NO. �� -j COUNTY .g*1 - -
NO, DESCRIPTION OF WORK FEE !-
HOUSE SEWER CONNECTING TO
PUBLIC SEWER_ @ $3.50 —
TYPE OF CONNECTIOP LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR �'
_FITS AND/ORDRAINFIELD @ $3.00 Y. CURB P.L -:� - M.L.TO P,L. r
OVERFLOW SEEPAGE PIT,ORAINF`IELD
EX.TN.,CESSPOOL,DRYW_ELL,MANHOLE @ $2-00
HOUSE SEWER CONNECTING TO -
I PRIVATE DISPOSAL SYSTEM @ $1.00 iRx P.C.N0,
.-_...?.-?8.--
CONNECT ADDITIONAL BLDG.OR -
__WORK TO_HOUSE_5EWER @ $1.00 TRUNK PERMIT NO. ROAD.PERMIT NO,
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE.ENCROACHMENT
INDUSTRIAL'-
:APPROVAL
NDUSTRIAL£APPROVAL <.y
OWNER'S PERMIT s t CO CONNECTION CHARGE Ff,6
AUTHORIZATION TOTAL FEEI ,'"�;: REaMBURs£MENx
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAL DATE 1INSPE:CTO
F,'SSiGNATURc;
TO THE PUBLIC SEWER. -- —
SIGNED Tli1S�4_,.-_..DAY OF _l 9NEW HOUSE SEWER
OWNER OR a CONNECT ADDITIONAL
OWNERS AGENT "�'"""''� _BUILDING OR WORK
ADDRESS! SEPTIC TANK,SEEP,PITS)
- -------- -- - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE AP,OVE 1S CORRECT AND AGREE TO COMPLY CESSPOOL L7 DRYWELL El
WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING -----'---
PLUMP.ING A14D SEWERS. ALTER.REPAIR,SEWER OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND �
CALIFORNIA OR THAT I AN THE LEGAL- OWNER OF THE ABOVE ABANDON HOUSE SEWER 1 _
DESCRIBED RESIDENTIAL�F3ROPERTY, - BACKFILL SEPTIC TANKS[.]
SIGNATURE - - SEEP. PIT(S) [I CESSPOOLS(]
OF PERMITTEE—
'` VALIDATION ROBERT A. WOOD
eases SUPERVISING 14ECHANICAL,ENGINEER
.P�