HomeMy Public PortalAbout5403 ROBINHOOD AVE_Sewer__ 76pgAPPLICATION FOR PERMIT 1
s&�.66s 1r-ws.es
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D i S POSA L
Department of County Engineer
County of Los Angeles BUILDING d'
JOHN A.-LAMBIE, COUNTY ENGINEER _ ADDRESS.,..5 03- }�}�„j,��„�(�O(, �J•��,' e
J CASSATT D.GRIFFIN, SUPT OF SWIDING LOCALITY Temple _-_---
__ FCJR APPLICANT TO FILL IN _ NEAREST r. Olive Street
q_
LEGAL OWNER R F�..t°�` Eg�`a.L�
DESCRIPTION LOT NO. r
BLOCK ?RACY
21704 MAIL q. _
_ ADDRESS torus -AyeX.$ue—
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT a,.
USE OF Residence DISTRICT NO. I GROUP MAP
x �y ��i����gg Construction
.y �tt _ BK PG
CONTRACTOR L.DwtJM. Vf)ns rucU�.on Cott
ADDRESS C-10 QX 20 —1111-,--v_ CONNECTION DATA
y� yam. AAAA /� STATION ,,✓q DEPTH
CITY .CjSiS.�. a 'Y4.'EL. N0. �Z4
-- P- MANHOLE REFERENCESTATE / 63
REGISTRATION N0. 113613 ❑ COUNTY r3� 0- -�`- LOWER
No.—IDESCRIPTION DR WORKFEE
HOUSE SEW'EReCONNECTTNG TO - TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 I --,j(}_ Y. �,_ CURB 4. M=L.TO P,L. �'...
I SEPTIC TANK SEEPAGE PIT OR
1Pd TS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT DRAINFIELD P. C. NO.
EXTN CESSPOOL,DRYWELL MANHOLE s S.2.00 I-� _ O. IMP NO. `._---J JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATEDISPOSALSYSTEMS —._til $1100- TRUNK PERMIT NO_-_ ROAD PERMIT NO. -_--
CONNECT ADDITIONAL BLDG.OR ` STATE ENCROACHMENT
WORK TO HOUSE SEWER n S 1,00
----- ---_AAAA...--AAAA--'.:----------I - _PERMIT NO.
ALTER.-REPAIR OR ABANDON HOUSE i INDUSTRIAL--- -- -_---J---- - -�-_
—y
I---SEWER OR DISPOSAL SYSTEM (ru,$1.00_ _J _ WASTE APPROVAL
AAAA — ----
— CHARGES
--- AAAA—
--- ------_.----------------:..-.----AAAA-AAAA...AAAA-----
CONNECTION CHARGE FEE
OWkCR'S--1 PERMIT_— 00
AUTHORIZATION TOTAL iii----j REIMBURSEMENT FEE
I HAVI AT THIS DATE A CONTRACT WITH THE HEREIN N D .. APPROVALS I DATE IINSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING j--�----
TO THE PUBLIC SEWER. NEW HOUSE SEWER I,
SIGNED THIS DAY OF 19 CONNECT ADDII'TONAL
—�— i_--- — --_—_—
OWNER OR Im, BUILDING OR WORK I
OWNERS AGENT ,ti'I 1:+ -
-^' — SEPTIC TANK,SEEP,PIT(S)_ADDRESS -----_-- -_. -AND/OR DRAINFfELD ---
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL0
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 SEWERS. SEWAGE DISPOSAL SYSTEM
! HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL yCOUNTY AND STATE OF ABANDON HOUSESEWER
CALIFORNIA OR THAI I AM THE OWNER OF THE ABOVE/ —_BAND --- ---. ---I --
DESCRIBED RESIDENTIAL WPERT ",✓J' ,' BACKFfL:.SEPTIC TANKS[j - +—
SEEP.PIT(S) 0 CESSPOOLS[j
SIGNATURE
�- __- AAAA--
OF PERMITTE - ( ----_.---
[OHIN A. LAMBIE, CouNTY GiNEER VALIDATION ROBERT A. WOOD.CHIEF PLSG,INSPECTOR
CASH