HomeMy Public PortalAbout4915 ARDSLEY DR_Sewer__ y ,
-61
75A6423-61
APPLICATMN FOR PERWT .
76A 642
COUNTY OF LOS ANGELES SEWER—SEWAGE DOSPOSAL
DEPARTMENT OF COUNTY ENGINEER ,,_
BUILDING AND SAFETY DIVISION 1-0
BUILDING
ADDRESS
JOHN A, LAMBIE, County Engineer
LI-915 ARTIALRY III?
WILLIAM A. JENSEN, Supt of Building_ LOCALITY TEMPLE CITY
FOR APPLICANT
TO � .. NEAREST TEMPLE CITY BLVD o
IN
CROSS ST.
LEGAL OWNER MARY PONNETT
DESCRIPTION LOT N0.
MAIL
s BLOCK TRACT14647 ADDRESS SAME
- NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 1 CITY TEL. NO
USE OFRES.
4 BUILDINGS RES o DISTRICT NO. GROUP MAP PROCESSED BY
i BK PG
CONTRACTOR REESE PLUMBING v'$ 1 '3
ADDRESS 424 S. MARENGO AVE CONNECTION DATA
CITYALHAMBRA TEL.N0. CU
/ STATION Gr •�— DEPTH V^
!` REGISTRATION NO. 150002 C36 STATE >? MANHOLE REFERENCE C/ PER
- ® COUNTY':' f Q} 5 tt�#KR
No. DESCRIPTION OF _R FEE
HOUSE SEWER CONNECTING TO •EiCJ
PUBLIC SEWER TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR / ���� CURB P.L. M.L.TO P.L. 3 `
PITS AND/OR DRAINFIELD @_�Ss99
OVERFLOW SEEPAGE PIT,DRAINFIELD ;7 _
EXTN..CESSPOOL.DRYWELL @.82.00 3 �
HOUSE SEWER CONNECTING TO -j P.C.N0. O
PRIVATE DISPOSAL SYSTEM CO.IMP. N0. JOB NO.
WORK TO ECTHOUOSEISEWEBLDG.OR 3sr e0 '} °I ,. TRUNK PERMIT NO. ROAD PERMIT NO. IX
SEWER OR DISPOSAL SYSTEM HOUSE @, STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL /
WASTE APPROVAL P�• �� N4 13p.
CHARGES z
s' ORS PERM JED QO CONNECTION CHARGE FEE
AMOMATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREICON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTLLING APPROVALS DATE INSPECTOR'S SIGNATURE
' TO THE PUBLIC SEWER.
SIGNED THIS DAY OF — ;'`I NEW HOUSE SEWER p
OWNER OR CONNECT ADDITIONAL r"
OWNERSAGENT BUILDING OR WORK 5-1/
ADDRESS
"'. ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I' HAVE READ THISATIONAND STATE THAT THE ABOVE IS. CORRECT AND AGRMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWSATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE141HEREBY CERTIFY THAT I AM PROPERLY REGISND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY TE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL WNER OABOVE BACKFILL SEPTICTANKS ❑
DESCRIBED RESIDENTIAL PROPERTY.SIGNATURE _ SEEP.PITS ❑ CESSPOOLS
OF PERMITTE
No
VALIDATION ROBERT A. WOOD
cK
As.0. CASH SUPERVISING MECHANICAL ENroINEER
Li(.�o 5 2 4 9:%23 !i,'6' 2-7 I - D J,(-' ISN 0
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