HomeMy Public PortalAbout5408 ROBINHOOD AVE_Sewer__ Sae•asa ts•ss
E-66 APPLICATION FOR PERMIT 1
S a
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING �y p y, q A
JOHN A. LFIMBIE, COUNTY ENGINEER _ ADDRESS X408 AOtJ{��!.11S hod AVt3Yl.ue -
g} CASSATT D. GRIFFIN, SU?'T OF BUILDING LOCALITY Temple "it -
NEAREST
FOR APPLICANT TO FILL INCROSS ST._ dot
LEGAL - ---
DEOWNER -' �.--
DESCRIPTION LOT NO.
- �, _- ,_(� }� Fj i t,7. 'i .I A
BLOCK TRACT 21704MAIL
-_ _ADDRESS Citrus Ave-`p�u
N0.OF BLDGS. CITY TEL. N0.
SITE OF LOT_ NOW ON LOT _
USE OF
BUILDINGS _Residence DISTRICT NO. k. GROUP I MAP
- - BK PG
CONTRACTOR _
— -- —� n -tib-P. 0.
�} /� CONNECTION' DATA -
-ADDRESS ,L"d 0. BOX 208 _._.-- - ----- --- - -- --
ply Q STATION e- r DEPTH
CIT C`�J.d�Iin Park TEL. NO.,L'D 8— 024 ---- � --�----��.� � --- «-. ---
MANHOLE REFERENCE _
'7 STATE _ + aim -. 'a'/ ': LOWER___
REGISTRATION NO, 113613 0 COUNTY
No. j DESCRIPTION OF WORK FEE
t-- - --- - -'-- ---- ----- ---- TYPE of CONNECTION..--",. LENGTH.FROM -
HOUSESEWER CONNECTING TO I Ye CURB P L. M.L. TO P.L.
PUBLIC SEWER - - -_i@ $3.501 _ .- ------_—_.- � ._.— .-
SEPTIC TANK SEEPAGE PIT OR
--�-PITS AND/OR DRAINFIELD (a $
�
OVERFLOW SEEPAGE Piz DRAINFIELD 1 - P C. N0.
EXIN.,CESSPOOL,DRYWELL.MANHOLE @ $2.00 _CO. IMP. NO. — JOB N0.
-� HOUSE SEWER CONNECTING TO --- --- - ----- - —^_
I
PRIVATE DISPOSAL SYS_TE_M_ _@ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
--4-
ADDITIONAL BLDG.OR STATE ENCROACHME14T
IWORK TO HOUSE SEWER (l $1.00 PERMIT N0. -
I ALTER,REPAIR OR ABANDON HOUSE ----��-- i— INDUSTRIAL-------- ----------------~�-----
I SEWER DR DISPOSAL SYSTEM ---$1.00 WASTE APPROVAL
- CHARGES -
CONNECTION CHARGE'FEE
OWNER'S PERMIT — 00
_—
REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED C APPROVALS DATE INSPECTORS SI GNATURE
-.__ _�
AUTHORIZATION TOTAL FEE
ON-
1 — ---- -- — —�TRACTOR --
TO CONNECT THE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF _� — NA—__- -{ - — �----
CONNECT ADDITIONAL
OWNER OR � BUILDING OR WORK
OWNERS AGENT --- SEPTIC TANK,SEEP,PITS) {
ADDRESS —_ AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL❑
AND STATE THAT THE ABOVE ]5 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM j
I HEREBY CERTIFY THAT I A14 PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF — -i
CALIFORNIA OR THAT I AM THE LEfi L OWNER OF THE AD OV _ABANDON HOUSE SEWER -�
-1-
DESCRIBED RESIDE PROPERT)ae 99 BACKFILL SEPTIC TANKS Ll
SIGNATURE '� Y Z LI SEEP.PIT($) CESSPOOLS[I
OF PERMITTEE _ -- - --- --- —I -
JOHN A. LAMBIE,COUNTY EN EER ��A�ATI�N ROBERT A.WOOD, CHIEF PG. INSPECTOR
CK.. m. 0. CASH
5 pO
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