HomeMy Public PortalAbout5404 ROBINHOOD AVE_Sewer__ 76AS42D
a E-663 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER —ADDR-E SS 5404 Robinhood Avenue
CASSATT D. GRIFFIN, SUP'-, OF BUILDING LOCALITY TemDle City
NEAREST, Olive Street
FOR APPLICANT TO FILL IN CROSS ST
LEGAL 14 OWN5
-
DESCRIPTION LOT_
BLOCK TRACT 21704 MAIL
A'A I L E Ss 550 Citrus Avenue
--DD
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY ( n-vri-nit TEL. NO.
USE OF
BUILDINGS Residence DISTRICT NO. GROUP MAP
BK PC
CONTRACTOR
on-c CONNECTION DATA
ADDRESS
CIT'
SiTA1 I ON f PTH
5—
Baldwin Park TEL. NO.
REFERENCE ED 8-302A STATE MANHOLE REF ,Z444�
Y'
4', WER
REGISTRATION NO.
D COUNTY
NO. ! DESCRIPTION OF WORK FEE
HOU, 5
TYPE OF CONN ECTIOkj--�-�', LENGTH FROM
f5-EW CONNECTING TO Y. CURB
PUBLIC SEWER------ @ $3.50 P.�.'j M.L. To P.L. zA
SEPTIC TANK,SEEPAGE PIT OR
]PITS AND/OR DRAINFIELD (0 $3.00
j OVERFLOW SEEPAGE PIT,DRAINFIELD I P. C. NO,
EXTN.,CESSPOOL,DRYWELL,M ANH04E a $2.00 0. )OB N 0.
HOUSE SEWER CONNECTING TO $1.00 ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM TRUNK PERMIT 40.
II
CONNECT ADDIT�i&N�41-EFLDG.OR j I STATE ENCROACHMENT
_I_WORK TO HOUSE SEWER ca s 1,0 0 PERMIT NO.
iiiiii ALTERREPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM
WASTE A
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 00
-- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE — 60
I HAVE AT THIS DATE A CONTRACT WITH THEHEREIN NAMED CON. APPROVALS DATE II.NSPECTOR'SSIGNAIURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF i9 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENTNeerSEPTIC TANK,SEEP,PIT($)
_ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL;. DRYWELLI
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE To COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR EWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
I Alf I�r4d%L OW N E R OF THE ABOVE
LICENSED AS REQUIRED BY LOS ES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT ABANDON HOUSE SEWER
DESCRIBED RESIDENT'A4:IP IITY--�
PRO BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S) Ll CESSPOOLS 0
OF PERMITTE
kmom
OHN A. LAMBIE, COUN;&ENGINEER -,,VALIDATION ROBERT A.WOOD,CHIEF PL13G. INSPECTOR
i)E G 0 A 5.0 0