HomeMy Public PortalAbout5419 ROBINHOOD AVE_Sewer__ 'SA64"
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APPLICATION FOR PERMIT
I)MMON O1BUILDING AND SAFTSEWER---SEWAGE
E D I S POSA L1
of qtr Enaftew
JOHM1t�I�Eof LCoutg@]As ENGINEER ADD Ina 1 ob7in�iood AvenvLe
BUI
m CASSATT D. GRIFFIN, EUP•T OF BUILDING LOCALITY� 10 Ci
EST
FOR APPUCAM TO FILL IN Ncaost m Street
LEGAL �, OWxEA Sohn B. Fitzgerald
D CRIPTIOY LOT X0. �n/h� /1 A
BLOCK TRACT
04 ADDRESS 0 CitiruB -A4enue
NO,Of BLDGS.
8 ZE OF LOT NOW OR LOT CITY TEL. NO.
USE OF
BUILDINGS Residence i DISTRIOT NO. GROUP YAP
I - BK 0
CONTRACTOR (lhn_qtrj3Ctjon' G.0 tff
ADaREss P. 0. PAYr POR com- ON DAxlL
cmBbldwia Park TEL. N0. ED 8-3024 STATION DEPTH
MANHOLE REF CK UPPER
STATE LOWER
REGISTRATION NO. 113613 COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CORNELTIXG TO TYPE QF COXNEC'I'I LENGTH FROM
PUBLIO SEINER S 0 Y• CURB• Y.L.TO P.L:
SEPTIC TANK,SEEPAGE PIT R
PITS AND/OR DRAINFIELD Q• 3.00-
OVERFLOW
.00OVERFLOW SEEPAGH PIT, DRAINFIELD - CO.i P. No. �be'no
EZTX„CHSSPDOL DRYWELL MANHOLE 2.00
HOUSE SEVER CONNECTING TO
PRIVATE DISPOSAL STEM Q 1.00 TRUNK PERMIT NO. ROAD PERMIT No.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 1.00 PERMIT NO. -
ALTER,REPAIR OR ABAND X HOUSE tNDU¢TR1AL
SEWER OR DISPOSAL SYST Y 1.00 FIASTQ IA-LPP'OTAJ
CHARGES
CONNECTION CHARGE FES ,
OWIE'S PE CT f 00
REIYBURSEXE]IT FEE
AUTHOSII.ATION L TOTAL
I HAVE AT THIS DATE k CONTRACT WITH THE HEREIN NAMED COX- APPROVALS DATE I” A'SSIGXATURE
TRACTOR TO COMq LL
CT THE ABOVE DESCRIBED EXISTING DWEIXG
TO THE PUBLIC DEM'ER. NEW HOUSE SEWER r t
SIGNED THIS SAY OF 19 CONNECT XDDIr1oRAL
OWNER GR BUILDING OR WORK
OWNERS AGENT Mew SEPTICTANK,BEEP,PIT(9)
ADDRESSAKD/OR DAA NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWEI,L❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE To CQMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTEA,REPAIR,8EWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL EM
1 "EREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANG COUNTY AND STATE OF BANDOX HOUSE SEWER
CALIFORNIA OR THAT I AY THE L OWNER OF THK ABOVE
DESCRIBED KPIDEHTI P BACKFILL SEPTIC Tpf1R.�❑
YIGN�ITURE BE P.PIT(S) ❑ CESSPOOLS❑
O!' PERMITTEE -
JOHN.A. LAMBIE. CouNTY erlGiNnim A MATIQN ROBERT A,WOOD,(;�1-IIRF PT IN#PKCTOR
�fLV� ■.0. rasa
LAW'1: 3 5 3 Ft 'mac 26 1 0 A_ s.a Q x
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