HomeMy Public PortalAbout5413 ROBINHOOD AVE_Sewer__ r6AC420 APPLICATION FOR PERMIT 1
S&E-663 11.55
DIVISION OF BUILDING AND SAFETY S EW E(J—SEWAGE DISPOSAL,
Deportment of County Engineer
County of Los Angeles BUILDING /�
JOHN A. LL.AMBIE, COUNTY ENGINEER aDDRESS_t6541.3Robinhood. AvenueA CASSATT D. GRIFFIN, SUPT of BVILDLNG `LOCALITY U^emple it
FOR APPLICANT TO FILL IN CROS ST. _iye Street —
LEGAL — OWNER y y,,, }
DESCRIPTION LOT NO. '21704 -MAIL---- - 83.Q_.�2�y_� . Fi ya�Ri,Z,�,�"C�.l d -
-- - --- 2170"'4'.. MAIL 55.0 citrus Avenue
BLOCK TRACT ADDRESS
T N0.OF BLDGS. -�------ CITY. `CC3'(T113.r'3l TEL. NO, --
SIZE OF LO_T_ NOW ON LOT
USE OF T.j ,g���G -_--- DISTRICT N0, .GROUP - MAP
BUILDINGS R .3.. _ BK PG
s_s
CONTRACT oeiY .., Construction O. -- T 1— 3 rr
ADDRESS P'r 0. Box 208 CONNECTION DATA
iF-
yp ^gam +�a pye�yg� � __STATION ,- DEPTH _
CIT.Bal d�Uin 'ark TEL.NO.�1) 8�-3021
-- MANHOLE REFERENCE r ----
STATE f'-LOWER
REGISTRATION NO. .113613 {1 COUNTY
No, DESCRIPTION OF WORK FEE
---- -- TYPE OF CONNECTIOJ&--, LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L M L.70 P.L.
PUBLIC SEWER @ $3,50 - - - ---- -- - ----
SEPTIC TANK,SEEPAGE PIT OR
_ _PITS AND/OR DRAINFIELD __ (ge, $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD -�� P. C. NU. .l' ,
_EXTN„CESSPO_0_L_,DRYWEL_L,MANHOLE @ $2,00. CO. IMP. NO. _ JOB N0.
--i HOUSE SEWER CONNECTING TO ��-f s
PRIVATE DISPOSAL SYSTEM_ Cu. $1.00 i TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.-OR -- --------- STATE ENCROACHMENT
VORK TO HOUSE SEWER _ �u' $1.00 L-^ PERMIT NO,
--�
ALTER,REPAIR OR ABANDON HOUSE ----.. -_ ----'- - -- ----J! -
_ SEWER OR DISPOSAL SYSTEM (i' $1.00 WASTE INDUSTRIAL
- _.--�— --- 'HASTE APPROVAL
j CHARGES
CONNECTION CHARGE FEE
OW'NER'S t?ERMiT 4 00 -------- ---
-- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _._--APPROVALS_ j DATE INSP- TOR'SSIGNATURE
..-. --`-T- - - - -
TRACTOR ---._-
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS DAY CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT W SEPTIC TANK,SEEP,PITS) - - -----
.ADDRESS AND/OR DRAINFIELD_.__.__
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL(] DRYWELL❑
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR --
LICENSED AS RE�:- ABANDON
H
JIRED BY LOS ANGE ES COUNTY AND STATE OF DISCONNECTPLUG AND
CALIFORNIA OR THAT I AM THE,-,'tEZAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIOENTIROnE;RTS' y BACKFILL SEPTIC TANKS
NATURE
SEEP.PITS) LI CESSPOOLS LD
s- --____-. _---- -- ------
OF PERMITYEE
IOHN A. LAMBIE. COUNTY rIG1NEER --,VALIDATION ROBERT A.WOOD.CHIEF PLBG. INSPECTOR
C M. Q. CASH