HomeMy Public PortalAbout4954 ROBINHOOD AVE_Sewer__ r-60
" APPLICATION # ■ • PERMIT
S 6o E•�fa�3�b6 •
DrVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX.COUNTY ENGINEER ADDRESS
pj CASSATT D.GRIFFIN/,SUP-T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN TNEAREST --
CROSS ST_
LEGAL
-DESCRIPTION_.LOT NO, OWNER
`�' OWNER
BLOCK '-- TRACT - �', MAIL
NO. OF BLDGS.
S17E OF LOT — NOW ON LOT _ CITY TEL. NO.
USE OF —
BULLDINGS DISTRICT NO.. 'GROUP MAF PG
BK
CONTRACTOR
ADDRESS CONNECTION DATA
-----------
CITY �L. NO -STATION DEPTH
'I! v°-
�,--.STATE MANHOLE REFERENCE - ---'UPPER
REGISTRATION N0. i' [.j COUNTY r' - LOWER
1I011 DESCRIPTION OF WORK FEE - ----'--_--__ -- __.-- --._._---
----"(-- "-- ------._.--- — TYPE OF CONNECTIOI: LE NTH FROM -
HOUSE S�.VER CONtiLCTtNG TO Y, CUPS P-:L. M.L.TO P.L.
�— PUSLIC srWER _ _ C7 $ 3.50 1 -
I HOUSE SBVER CONNECTING TO
__--f PRIVATE DI-40_S_AI SYSTEM__
f` CONNECT ADDITIONAL BLDG" OR I P C NO
-i
TO0_USE SLVIER 1.00_) _ CO. IMP. NO. 106 NO,
I
ALTER OR REPAIR EXISTING _ .,TRUNK PERMIT 140. ROAD PERMIT NO,
SEtVER OR DISPOSAL SYSTEM OD
D SC01` E
M
I -CT AND ABANDON SEWER i
—_—i
AND/OR DISPOSAL$YSTFM ?,00 I STATE ENCROACHMENT
PERMIT NO.
SEPT11 TANK,SEEPAGE PIT OR
PITS AID/OR DRAININDUSTRIAL
_FIELD 4001 WAST/• APPROVAL
CESSPOOL DRYWELL -..�,
SPECIAL CONDITIONS ONLY ____ 2.00 -- - - _----.� CHAR_ESv��_,-._..____.____.._ _
CONNECTION CHARGE FEE
OWNER'S PERMIT S tT 00 --- --- --- --- - -
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
F
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- v
CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER �' —� '—{ ------ '---s -----
NEW HOUSE SEWER "C
SIGNED THIS E)AY OF...—,
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT -._ :' BUILDING OR.WORK
SEPTIC TANK,SEEP, PIT($)
ADDRESS-_.T '— .,_�"--- .--�—'---. AND/OR DRAIN€IELD _
I HBRE$Y ACKNOW'L5DGE THAT I HAVE READ THIS APPLICATION CESSPOOL Q LSRYWELL
AND STATE THAT THE ASOVF IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER REPAIR,SEWER OR --^
FLUM9'.NG AND SEWERS. SEWAGE DISPOSAL SYSTEM
I
LICENSED AS REQUIRED BY LOS ANGHERESY CERTIFY 'THAT I AM PROPERLY REGISTERF',D AND/OR DISCONNECT PLUG AND iANGELESCOUNTY AND STATE OF i - m
CALIFORNIA OR THAT I AM "fHE LEGAL OWNER OF THE ABOVE _ABANDON_HOUSE SEWER
DESCRIBED P.ESID`IENTfAL PROPERTY, BACKFILL SEPTIC TANKS Ci
SEEP_. PIT(S) D CESSPOOLS LU _
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLEG. INSPECTOR
0s 0 lilb 4.5