HomeMy Public PortalAbout5424 ROBINHOOD AVE_Sewer__ S,S4&D
s a aaea t1.ae APPLICATION FOR PERMIT 1
DIVISION OF BUIMMG AND SAFETY S P-W E R—SE��AGE DISPOSAL
Dint of Co=aiy Eughum
Cooatt of Los AaQalas ADDEFBS° 24 RObinhood �v9IIue
JOHN A. L4MBIE, COUNTY ENGINEER
m CAdHATT D. GRIFFIN, Sup-r of EuILDIno LOCALITY
FOR APPLICANT TO FILL IN "0"iqFAkST.Olive Htreet .
LEGAL OWXER
DIi.ECRIPTIOX LOT X0.
PAIL
BLOCK TRACT 21704ADbRHBE
N0.OF BLDGB. CITY TEL. M0.
SIZE OF OT NOW ON LOT
USE O
BLHLDIXGS Residence DISTRICT NO. GROUP SAP
B[ P
CONTRALTO GO '
ADDRESS
CONNECTION DATA
,
cITBaldwin Park TEL. XO. 0 STATION DEPTH
SANHOLH REFERENCE PPER
X1 STATE
REGISTRATION NO. 113613 ❑ COUNTY
NO. IJESCRIPTION AF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CON
NiCTI LEP.
FROM
PUBLIC SEWER S,Sp I. CURB F. Y.C.T9 P.L
8[PTIC TANK.SEEPAGPIT OR
PITS AMD/OR DRAIXFI�LD @ 5.00-
OYiiRFLOW BEIPAGE PIT,DAAIXFIELD P. C. N0.
PT
DRYWELL MANHOLE 2.00 CO. ISP. XO. JOB No.
HOU39 SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM s 1.00 T-RUNX PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 1.OD PERMIT NO.
ALTER,RQPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DLSPOSAL SY=br 11.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S I PEEMIT s I A oo
AUTHORTULTION TOTALREISBUR9ESENT FEE
.`
I HAVE AT THIS DATE A COIITRA& ■LTH THE HEREIN NAMED COX- APPROVALS DATE IXSPE R'SSIGXATURE
TRACTOR TO COXNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC 8EWER. NEW HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
OWXER ORBUILDING OR WORK
OWNERS AGENT Yaw
SEM C TANK,BEEP,PIT(5)
ADDRR%%l AND/OR DRAIXFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CES"OOL❑ DRYWELLM
AND STATE TH4T THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL CO XTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HE"_9Y CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICEXSED AS REQUIRED BY LOS ANGELES COUNTY AND STATS OF
CALIFORNIA OR THAT 1 AN TH AL OWNER OF THE AlloysABASDOX HOUSE SEWER
DESCRIBED HEIIDEXTI PROP BACKFILL SEPTIC TAMIL!❑
SIGNATURE
SEEP.PITS) ❑ CEJ u,"I l❑
OF PERNITTEff-, KE_t�I I I
JOHN A. LAMBIE.COUNTY E GINNER VALIDATION ROBERT A.WOOD,Cr111F PUBO. INSPECTOR
cL
1.0. CASE
LCI 3 5 92R 0M 26 .1 0 A 5.00