HomeMy Public PortalAbout5414 ROBINHOOD AVE_Sewer__ 38AE-66�11-55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Log Angeles BUILDING ry
JOHN A. LANIBIE,COUNTY ENGINEER -°._DRESS �„4 Painb�r,0(F d Avenue
CASSATT D. GRIFFIN, SUP'TOF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN NEAREST Olive Street
CP.OSS S7'.
LEGAL
DESCRIPTION LOT NO, 12_---._ OWNER-John R. Fd�,'ty`�_ge:i','��(�—.
—_--------- — ----
MAIL
BLOCK TRACT _ - -_ AD➢REBS _50-_50--citrus- e --
NO. OF BLDGS. CITY TEL. NO.
_SIZE OF LOT _ NOW ON LOT ovina
USE OF — DISTRICT NO. GROUP MAP
BUILDINGS_ PG
CONTRACTOR • •Ctio L+_
dt _
ADDRESS Box
CONNECTION DATA
CITY Ee°�lE�.@fiin ParkTEL. NO..ED 8-3024STATION
-- —
------� MANHOLE REFERENCE
1y STATELOWER. r
REGISTRATION NO. .3613 [] COUNTY "�...._v-
NO. i DESCRIPTION OF WORK FEE - — — -- — -
HOUSE SEWER CONNECTING TO — TYPE OF CONNECTION�--*+ LENG"fFI FROM
Y. CURB ap"� M L.TO P.L. --
PUBLIC SEWER-- @$3.50) -- -- = — - --- -.._..—
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAiNFIE_LD (Cc $3.00 _--_.-
j OVERFLOW SEEPAGE PIT,DRAINFIELD -- - P C NO. ,sa +x �,✓:
k.X_TN_CESSPOpL,DRYWELL,M_ANHOLE $2.00 CO, IMP NO. JOB_NO..
i HOUSE SEWER CONNECTJNG TO t-
I PRIVATE DISPOSAL SYSTEM __ (q% $1.00 f TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR - - STATE ENCROACHMENT
WORK TO HOUSE SEWER (q $1.00 I PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSEINDUSDDS
SEWER OR DISPOSAL SYSTEM C $1.00 ��- — TRIAL - ----�--- -�--^ --
.� - ._ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT ��' 00 --� — — -� - ----
- --"' _ REIMBURSEMENT FEE
AUTHORIZATION TOTAL £EE I APPROVALS
DATE INSPECTOR'S SIGNATURE
'
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ _..
TRAITOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - d
TO THE PUBLIC SEWER. NEW HOUSE SEWER '1
SIGNED TfiIS DAY OF— 19CONNECT ADDITIONAL ----
OWNER OR BUILDING OR WORK._
OWNERS AGENT New -----r- -_4__
-- SEPTIC TANK,SEEP,PIT(S) �- ( ---
— ---
ADDRESS AND/OR DRAIN_FIELD
I HEREBY ACKNOWLEDGE. THAT 1 HAVE READ THIS APPLICATION AND/OR
DRYWELL[.1
AND STATE THAT THE ABOVE 15 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 DISCONNECT PLUG AND �
LICENSED AS REQUIRED BY Lfl5 ANGEP COUNTY AND STATE dF - ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE A. OWNER. OF THE ABOVE --- - ---- -- -
DESCRIBED RESIDENT PROPER " BACKFILL SEPTIC TANKS
.✓� ` ,f
SEEP.PIT(5) '�„ CESSPOOLS❑ 4—
SIGNATURE
OF PERM ITTE -
IOHN A. LAMBIE,COUNTY GINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CASH