HomeMy Public PortalAbout4955 ROBINHOOD AVE_Sewer__ 76F
£-663 3-55 ■APPLICATION FOR PERMIT
ffi& •66
DIVISION OF BUILDING AND SAFETY ---- SEWER-SEWAGE D I S POSA L
Department of County Engineer
a County of Los Angeles BUILDING
ADDR ✓ -
W N.J. FOX, COUNTY ENGINEER --- –
CASSATT D.GRIFFIN,SUP+'T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
ceoss sr_
LEGAL y's
DESCRIPTION LOT NO.__ OWNER ,-
BLOCK TRACT - `
VMA L
> 54
NO. OF BLDGS. — 5 ----
_54Z_E NOW ON LOT CfTY �!�' TEL, NO.
USE OF -_—
BUILDINGS ,,. DI5't'F.ICT NOe GROUP ; - MAP
BK PG
CONTRACTOR
CONNECTION DATA —
ADDRESS �' 6 ...� �� •Xi�c�
CITY "'�..'> ,�" <1 > NO. .P`° "` =` STATION - ° DEPTH
:',� *',.1 ".J / ter✓ /L'
STATE MANHOLE REFERENCEUPPEP�,
REGISTRATION N0. ��,✓f.� t, COUNTY
NO. DESCRIPTION OF WORK FES --- ---- — _-- .—
�� TO P.L.
HOUSE SEWER CONNECTING TO — TYPE OF CONNECTION LENGTH FROM
_PUBLIC SEWERi)RB _ I1 L.
r-- .
HOUSSEWER CONNTITO
HOINETfDDIS?O5AL SYSTEM
1,00!_
VORO HOUSE SE NFP
BLDG. OR -I - --�--._.-- P.B N. -
dO CONNECT T HOUSE SC..VER 1.00�_ I CO. IMP. NO, JOB NO: '
ALTER OR REPAIR EXISTING
SE1dER OR DISPOSAL SYSTEM 1,0➢ — TRUNK PERMIT NO. - ROAD PERMIT NO.
DISCONNECTAND ABANDON 'SEWER
—.
_ ACt D/OR DISPOSAL (STEM_ 9,x^,0 STATE ENCROACHi,1ENT
.� ---- -- PERMIT NO,
S PT?C TA do SEEPAGE PIT OR ,' . 1
PIIS AND/OR DRAINFIELD_ 00 INDU iRIA'L
CESSPOOL-DRYWELL — BASTE APPROVAL
SPF CtAL CON^uITIONa ONLY 2..,0 CHARGES
--- --.— ---` ----� CONNECTION CHARGE FEE
g ti_uo
OWNER`S PERMIT
AUTHORIZATION TOTAL FEE � � �i �• REHAeI RSEMEN? FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED COPi- APPROVALS
F
TRACTOR TO CONNECT HE ABOVE DESCRIBED EXdSTING DWELLING FPPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEVER —
> NEW HOUSE SEWER p
SIGNED THIS ___DAY OF
OWNER OR !' W CONFECT ADDITIONAL
OWNERS ACENT �^ � .�� ���;: _�„�'.-r ..--y. BUILDING OR WORK -V-- T
SEPTIC TANK,SEEP,PIT(S) I
_AN_WOR DRAINFIEL_D___
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL C] DRYV?ELI.[I —a--
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMPING AND SEWERS' _SEWAGE DISPOSAL SYSTEM_
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I APS THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE- SEINER
DESCRIBED REs DENTIALOPFRTY , ' {{
r .� SACKFILL SEPTIC TANKS P--
SEEP.PIT(S)
SEEP.PIT(S) [I CESSPOOLS C] I
SIGNATURE
OF PERMITTEE Xi'.,..o 'i' v ',,.t� i�✓! t ff
WILLIAM J.FOX.COUNTY EtStGINEca VALIDATION R.A.WOOD, Cta1EF F'L•E'G. INSPECTOR
h. .,