HomeMy Public PortalAbout5429 ROBINHOOD AVE_Sewer__ f ,
j, ;,It-on APPLICATION FOR PERMIT
Dri'MON OF $UILDING AND SAFETY SEWER—SEWAGE bISPOSAL
Dsparftmnt of Co—tT Mm tnow
CooaiT Of Los AnQal- Bu' 7
ADDRESD o j nhoo8Avenue
JOHN A. LAMBIE, CouNry ENGINEER
m CABDATT 0. GRIFFIN, SUr'T of BUILOINO LOCALITY T le -0i
FOR APPLICANT TO FILL IN "Z s
LS IP 6 OXER rohn R. F`itAgerald
DES IPTION LOT 110. /�
BLOCK TRACT 21704 ADDMAI1
ADDRESS Of true Avenge .
ADD
110.OF BLD GS. C TEL. 110.
SIZE OF LOT NOW ON LOT
USE OFDISTRICT NO. GROUP SLAP
BUILDIXo9
- BK PG
CONTRACTOR
P. - O. Bog 208 COIT F Dana
ADDRESS ,,,.;„ y p �y
cmd%ld d-TL Park TEL. N0, 10 8-3024 hTIbN E DEPTH
YAAHOLB REFERSIICir zL z UPPER
$1 STATE
REGISTRATION NO, ❑ COUNTY -
Xo. DESCRIPTION OF WORK ME
HOUSE SEWER CONNECTING TO TYPE OF COM10 LENGTH FROM
PUBLIC ER 9.D0
T_ CURBB 1. Y.L.TO P.L
SEPTIC TAmK,SrEPAGE PIT OR
PITS AAD/OR DRAIXFIEL.D 0 9,00-
OYBftFLOW SERFAGE PIT,DRAI"FIELD P. C. N0.
EZTN.,CESSPOOL DRYWELL ANHOL.R 2.00 CO, IMP. N0. JOB X0.
HOUSE SEWER COIIXECTING TO
PRIVATE DISPOSAL SYSMM 0 j 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER f 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
.SEWER OR blSPOSAL tYS7EY 11.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FE[
OWNEE'S PEEICT s OL 00
AUTHORIZATION �TOTJLL FEE REIMBURSEMENT FEE
1 HAYE AT THISDATE A CONTRACT WITH THE HERKIN HAYED CON. APPROVALS "DATE INSP OR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EZ19T1NG D1/ELLING
TO THE PUBLIC SEWER. NEN HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
OWNER OR �� BUILDING OR WORK _
OWNERS AGEAT SEPTIC TAAK;SEEP,PIT(9)
ADDRESS AND/OR DRAINFIELD
1 HEREBY AFKHOYLEDGM THAT I HAVE READ THIS APPLICATION CESSPOOL[3'DRYWELL❑
AND STATE THAT THE ABOVIL IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORPIMANCR!f AND STATE LAWS REGULATING AI,TER,REPAIR,SEWER OR
PLUMBING AND SEWERS. 3EYAGE DISPOSAL SYSTEM
1ICHEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DL9COXXECT PLUG AND
LENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AY THE.L90AI OWNER OF THE ABO
Y ABANDON HOUSE SEWER
DESCRIBED RUIDENT1At PERTY BACKFILL BEPTIC TANKS ElSIGNATU RR SEEP.PITS ❑ CESSPOOLS❑
OF PEHMITTYE
JOHN A. LAMIOIE. COUNTY ENGAEERVALIDATION ROBERT A.WOOD, CHIQr PtEIG. INDPSCTDR
`�1 3 5 59-�"26 1 0- A 5.00
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