HomeMy Public PortalAbout5537 ROBINHOOD AVE_Sewer__ 4eeAPPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D I S POSA L
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IX0JOHN A. LAMBIE, COUNTY ENGINEER ESSCABDATT D.GRIFFIN, Sur"f-oF BUILDING I.ITT
FOR APPLICANT TO FILL IN cRoR�rr.
L$GAL 7 a-, O*E
DESCRIPTION LOT NO. (/
M uIL
BLOCK TR1ka G l ADDRESS
No. OF BLDG$. Y SEL. N0.
SIZE OF LOT NOW OR LOT
USEOF
BUILDINGS DISTRICT BK GROUP M"
BUILDINGS PG
CONTRACTOR A423L �¢
CO>K![F.G7ION DATA
ADDRESS
CITY TEL. (� a+ STATION', DEPTH
WIHOLE EA
STATE LOWER
REGISTRATION NO. COUNTY
NO. DESCRIPTION OF WORK FEE.
HOUSE SEVER CONNECTING TO TYPE OF CONNECTION H FROM -
Y. CURB P.L. M.L. .L.
PUBLIC SEWER 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 5.00
OYERFLOW SEEPAGE PIT,DRAINFIEJ� P. C. N0.
QTN.,CESSPOOL DR YANHO 2.00 . IMP. No. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 1.00 TRUNK PER XO. ROAD PERVIT NO.
CONNHCTADDIT ONAL BLQG.OR. BT1yTE EX OACHMERT
WORK TO HOUSES ER 'a f 1.00 PERMIT 0.
ALTER,REPAIR OR ABANDON HOUSE
/ SEWER OR DI SPO
AL SYSTEM @ 11.00 O d IVDU IAL
W APPROVAL
CHARGEE
CONNECTION CHARGE PEE
OWNER'S PERbUT $ t 00
REIMBURSEMENT FEE
AUTHORMAnON MTAL FEE p I _
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA-RED CON- APPROY DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NE►HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AOET 9EPTIC TANK,SEEP,PIT(S)
ADDRESSr44c-;7--I�VAND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL D
AND STATE THAT THE ABOVE IE CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMPING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTLFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO(1NTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM TH LEGAL OW ER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑
SIGNATURE DEEP. PITS CESSPOOLS El
C�
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER / ij ATION ROBERT A.WOOD, CHIKF PL.DG. INSPECTOR
X.O. WH
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