HomeMy Public PortalAbout5621 ROBINHOOD AVE_Sewer__ °AD'= APPLI�CATION�' FOR PERMIT
`` D I;FVYS N-OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
�� BUILDING
WM. J. FOX, COUNTY ENGIINKIER AD REBS
CASSATT D. QRtFFIN. SUPT of SUMMING LOCALITY
FOR APPLICANT TO FILL IN NEAREST •
cRofs Sr.
LEDA
DESCIRILOX LOT NO. 7.1 0*NEII
BLOCK TRACT MAIL
ADDRESS
NO. OF BLDGS.
SIZE OF LOT XOW OX LOT CITY -oor TIL NO.
USE OFDe
L
BUILDINGS L/CrNa 4- DIBTR[�. GROUP
I eMAPP9
CO MACTO
ADDRESS CO!(HEC.'TION DATA
CITY 1 TIL NO. STATION ' DEPTH
STATS MANHOLE REFERENCI
REGISTRATION NO. COUNTY UPPER LOWER
OF CONNECTIONLENGTH FROM
N0. DESCRIPTION OF WORK FES 1'• CURB Y.L.TO P.L
HOUSE SEWER CONNECTING TO
'PUBLIC SEWER 5.60
HOUSE DEWIER CONN CTIHG TO
PRIVATE DISP05AL SYSTEM 1.D0
CONNECT ADDITIONAL BLDG. OR CO. IRP. NO. OD. X0.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 �D TRUNK PERMIT NO. R PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHY
XD/OR DISPOSALS STEM 1.00
PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPR L
SPECIAL CONDITIONS.ONLY 2.00 CHARGES
CONCTIOR CHARGE FTSE
OW2�'S �T $ 1 00
AUTHORTZATION I TOTAL FEE' # P REIMBURSEMENT FEK
I HAVE THIS DATE CONTRACTED WITH THE HEREIN RAYED CON- APP$OYALS DATE IXSPECTOR'3 SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLIIJG
TO THE PUBLIC ER
SIGNED THI OF 19
NEW HOUSE SEWER
OZHER OR
CONNECT ADDITIONAL
OIVXERS AGER BUILDING OR WORK
-SEPTIC TANK, SEEP, FIT(f)
ADDRES ACKNOWLEDGE '�i AND/OR DRAINFIELD
AND HfTJ HEREBY
THAT TTHBOVE IST CORRECT AND AGREL TO rnIFLLY C��OL❑ DR17E,.LL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, RIPAIR,SEWER OR
PLUMBING AMD SEW ". SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR
LICEMBED AS REQUIRED BY LOS ANGELSB UNTY D STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AY THE LEQ X THI AROYE ABANDON HOUSE SEWER
DESCRIXED RTDIDXHTIAL RLRTY. 11ACICFIIJ. C TAXIS
iESP.FIT f 'MpQ'
SIGNATURE
OF PERMI
V6qLJ_1AA1 J. FOX,COgoENOILKmt 'a
: 1 5 9 i� -MAR-14 4 2.0 0 e
DIFUTT DEPUTY
BY tt
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DEPUTY }