HomeMy Public PortalAbout5418 ROBINHOOD AVE_Sewer__ 9.6o
S& APPLICATION FOR PERMIT 1
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DIVISION OF-BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING 41$ Robinhood Avenue
JOHN A. LAMBIE.COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY TL'.1Tiple rites --�-
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NEAREST 1y ive &9treet
-_—FOR APPLICANT, TO FILL IN _ ;,Ross sr. O
LEGAL
DESCRIPTION1 _---- -- OWNER �TAhrr '
LOT N0. •i. CL.LLL
17 MAIL _
BLOCK TRACT ADDRESS
N0. OF BLDGS. CITY TEL. N0.
SIZE O_F_LOT NOW ON LOT
USE OF
DINGS ReS`t. �. Yt A
DISTRICT NO, GROUP MAP
PG
BUIL _ —
CONTRACTOR L— D, 8,
/� B f�, CON'N C.TT ION DATA
ADDRESS_ !!® .L3 'i 2U —. ._�. -- -
• _ STATION DEPTH �,,
CITYB��(, jj ParkTEL. NO. ED _-_ MANHOLE REFERENCE BUPPER ,
_ ryry ^� �C.! COUNTY
�
REGISTRATION NO. 11 61 _- -----
NO, ; DESCRIPTION OF WORK FEE - —
—`f -i-- -- --N-- --.. TYPE OF CONNECTIOy.,'3,' LENGTH FROM
HOUSE SLN/°R CONNECTING TO —
j Y. CURB r P.L. M.L. TO P,L.
--I
PUBLIC SEWER $_3.501 _I ---- �__
SEPTIC TANK,SEEPAGE PIT OR � I
PITS AND/OR DRAINFIELD c' $3.Q0-� I ------._--. __
OVERFLOW SEEPAGE PIT,DRAINFIELD ` P. C. NO.
EXTN.,CESSPOOL;DRYWELL,VIA NHOLE(d $2.00 f CO. IMP NO,. 70B N0.
HOUSE SEWcR CONNECT TNG TO
PRIVATE DISPOSAL SYSTEM (a $1.00 TRUNK PERMIT NO _ _ ROAD PERMIT NO. —_ —
CONNEC ADDITIONALBLDG_OR } STATE ENCROACHMENT
WORK 70 HOUSE SEWER ct $1.00 PERMIT N0,
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
_SEWER OR DISPOSAL SYSTEM Gc S M,00 ? WASTE APPROVAL
fCHARGES
CONNECTION CHARGE.FEE
OWNER'S PERMIT � _-- —.
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON= APPROVALS 1, DP.TE (INSPECT R'SSIGNATURE
TRACTOR 'TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - NEW HOUSE SEWER I
SIGNED THIS DAY OF 19__ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK_
OWNERS AGENT I�TP.' __.—
SEPT➢C TANK,SEEP, PIT(S)
-� - - '---__�_--
LE
'
S AND/OR DRAi_N_F_I_ELD _
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO DRYWELLDATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR.NG AND SEWERS. SEWAGE DISPOSAL SYSTEM
REBY CERTIFY THAT I AM PROPERLY REGISTERED AND;OR DISCONNECT PLUG ANDED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDgN HOUSE SEWERRNIA OR THAT I AM THt LE .AL OWNER OF THE ABOVE BED RESIDENTIA PROPER ! BACKFILL SEPTIC TANKS❑
SEEP.PITS) D CESSPOOLS 0URE rRMITTEE - -
i
JOHN A. LAMBIE,COUNTY E INEBR_ ALIDAT'ION ROBERT A.WOOD,CHIEF PLEIG, INSPECTOR
Q. CASH
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