HomeMy Public PortalAbout5430 ROBINHOOD AVE_Sewer__ a,X-e-ana nye
a APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SF-WAGE D I S POSA L
D.pwftumt of-uCour Eayyla«s
Cor Of 2 AnQa+lM BUILDING
JOHN A. LAMBIE, CouNTY ENGINEER ADDRESS
5430 Robinhood Avenue
m CAHBATT D. GRIFFIN, BUI•T OF BUILDING L.00ALITT l:emple City
14 EAkEST
FOR APPLICANT TO FILL IN CROSS BT. 011 VA Rt:-rPlAt
LEGAL
DER IPTION LOT NO.
BLOCK TRACT 217 MAIL
D REaf 550 C tru.H gYBIIue NO.OF BLDG-S. CITY Oovina TEL. NO.
SIZE OF LOT n0■ON LOT
0 OF DISTRICT N0. GROUP YAP
BU LDIRGB A R an rub
R PG
CONTRACTOR
ADDREI>♦. CONNECTION DATA
r
STATION -41Z 6 DEPTH
CI TEL 710. MANHOLE REFERENCE UPPER
=1 STATE
REG0171ATION NO. 1 ❑ COUNTY
no. DESCRIPTION OF WORK FSE TYPE OF CONRECTIO LHIIGTH FROM
'HOUSE•ISRWER CONNECTING TO Y. CURB P.L.' Y.L.T6 P.L
PU LIC SEWER @ 3.60
SEPTIC TAJfR,SEEPAGE PIT OR
P1TB MD/ORD INFIELD 3.00
OVERFLOW SEEPAGE FIT,DRAINFIELD P. C. N0.
+ EKTX.,CE.SSPOOL DRYMELL,MANHOL.E 2.00 CO. 1 x P. I0. JOB N0.
S HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSALSYSTEY gp 11.00 TRUNK P MIT NO. ROAD PERiITNo.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE EEM f 1.00 PERMIT NO.
I 'ALTER,REPAIR OR ABANDON HOUSE
INDUSTRIAL
SEWER-OR DISPOSAL SYSTEM 1,00
BASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OVnmlS PST s 00
RH1YB11RBEYEXT FEE
AUTHOBPLATION TOTAL. FEE
I HAVE AT'THIS DATE A CONTRACT WITH THE HEREIN NAIED COn- APPROVALS DATE INSPE OR'SSIGNATURE
I TRACTOR TO CONNECT THE ABOVE DESCRIBED rXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWXHRB AOEIfT SEPTIC TANK,SEEP,PIT(5)
ADDRESS AILD/OR DRAINFIEL.D - -
I HEREBY ACENOWLEDGE THAT I HAVE READ THIS APPLICATION CE63POOL❑ DRYAELL❑
MD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND ITATi LAMB REGULATING ALTER,REPAIR,SEWER OR `
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1LICHEREBY CERTIFY •THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
ENSED AM REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T AL WXER OF THE ABOVE
DESCRIBED RIES IDEX ROP BACXFI L SE El CPTIC ESSPOOLS ElANKS
OF PERII
JOHN A- LAMBIE.COUNTY GINGER ALMATION ROBERT A.WOOD,gHIQrPL.BG. INSPECTOR
fP
=, 3 5 89R DEC 26 1 0 !1 5.0 0 A