HomeMy Public PortalAbout5431 ROBINHOOD AVE_Sewer__ 7ZA&4AID"41APPLICATION FOR PERMIT 1
DMSION OF BUILDING AND SAFETY SEINER—SEWAGE DISPOSAL
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JOHN A. L4MBIE. CouNTY ENOINesR �� 1Q Ci��-v
m CA BATT D. GRIFFIN, DUP'T pF BUILDING UTT P �J -
FOR APPLICANT TO FILL IN ROM.
LE6AL �
DESCRIPTION LOT N0. -
YAHL
BLOCK TRACT ADDRESS
NO. OF BLDGS. CITYTEL. NO.
SIZE OF LOT NOW OR LOT
USEQpF
BUILbINGD DISTRICT NO. GROUP - YAP
PG
CONTRACTORS
ADDRESS -
CO ON DATJ4
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STATIONDEPTH
CI TEL N0.
11 MANHOLE RRFFRRIICE UPPER
REGISTRATION N0. . 113613 o OCH Y
N6. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECT] LEf(GTH FRO■ .
PUBLIC SEW 9.10 Y. -CURB F.L. III.L.
TO F.L.
SEPTIC TANK,SE$PAGE PIT OR
PITS AND/OR 15RAINFIELD 8 9.00 �J
OYERFLOW SEEPAGE PIT,DRAIYFIELD CO. IRP. Y0. JOB NCO. �+
EXTH.,CMP-00L DRYWELL YAXHOLE 1.00
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM S-1.00 TRUNK PERMIT NO. ROAD'PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE IYDUMIAL
SEWER OR DISPOSAL SYSTEM 41.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'$ PERbUT s 00
REIYBURSEYENTFEE
AUTHORIZATION TOTAL Fn
I HAVE AT THISDATE A CONTRACT WITH THE HEREIN RAYED COY- APPROVALS D TE INSPE R'&SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER A.
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
N
OWNER OR �* BUILDING OR*OR IC
OW It
ASINT SEPTIC TANK,SEEP,-PIT(3)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION CESSPOOL❑ DRY
WITH
AND STATE THAT THE AB OV
If CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCFS AND STATE LAWS REGULATING ALTER,REPAIR,SEWER
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYS;:
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENWD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AN T AL OWNER OF THE OVE ABANDON HOUSE SEWER
DESCRIBED RESIDfi ROP f-' BAC[FILL SEPTIF TAN[B❑
SIGNATURE SEEP.PIT D) ❑ CHSSPOOLS❑
OF PERIITTEE
JOHN A. LAMBIE, CouN NOINEER ATION ROBERT A.WOOD.-CHixF PL.DO. INCP[CToR
1.0. CATH .
AD} 3 5 6 OR DEC 26-1 0 A 5.0 0 A
I .