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003697 (SFD)
tyl " P.O. BOX 1504 No. • 003697 Building 78-105 CALLE ESTADO Address 53"755 Obregon LA QUINTA, CALIFORNIA 92253 Owner Coachella Vallee Lan *Co..—BUILDING:-TYPE CONST. OCC: GRP. - Mailing ^ Address A 7 V. 4 v ft%f .4 " A.P. Number 77A_1 AA—fl I I City Zip Tel. _ . ' , w .. 4:. . - . - - - � � 2262 ?22-1020:. Legal Description Contractor . _ -..',. x... _ -- Project Description .ty.F•>,k�vt� tf`,n1rllcx+F ni•�n,�x Address . _ .. Saab ,. .. .CitZip y _...... _ . . State Lic. City & Classif. 387934 Lic. # - 89!i „ y . Sq. Ft. 1463 No. No. Dw. _.. . Size:! Stories - Units* -Arch., Engr., Designer New ❑ '. Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. �• 701 of 5' wood fence City Zip State Lic. # - LICENSED CONTRACTOR'S DECLARATION > I hereby affirm that I,am licensed under provisions of Chapter -9 (commencingwith Section ' r+ e0Iff0e0)t f Division 3 /of -the Business and pP Professions Code, and my license is in full force and SIGNATURE -r< •' 'e, " ' ' 'G.r 'DATE:' e/ OWNER -BUILDER DECLARATION Estimated .Valuation I hereby affirm that I am exempt from the Contractors'Llcense Law for the followinga reason:,=(Sec. 7031.5,Susiness and Professions Code: Any city or county. which requires a permit to. construct, alter, improve, demolish, or repair any structure, prior to,fts issuance also - ., r., . requires'theapplicant for such permit to file asigned statement that he is licensed pursuant to PERMIT • AMOUNT the provisions of the Contractor's License Law, Chapter -9 (commencing with Section 7000) of Division 3 of'the Business and' Professions Code, or that. he Is -exempt therefrom, and. the. basis- for asis - A°- Dor the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant "for a permit -"Plan Chk. Dep. - u5�Q AO subjects'the applicant to a civil penalty of not more than five hundred dollars ($500). - ' ' _ 01 as owner of the property, or my employees with wages as theii sole compensation, will Plata Chk.. 681...,59 .89 -do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and' COf1St. Professions Code: The Contractor's License Law does not apply town owner of properly who s 00 builds or improves .thereon and who does such work.himself or through -his own employees, Mech.' sg � - provided that' such Improvements are not intended or offered for sale. If, however,' the,building •. ��D s W . or. improvement is sold within one year of completion, the owner -builder will have the burden Electrical - - w� �y of proving that he did not build or improve for the. purpose of sale.) f 5 a Q 7 , ❑ 1, as owner of the property, am exclusively contracting. with licensed contractors to con- Plumbing "� p struct the project. (Sec. 7044, Business and Professions Code: The •Contractor's License Law _ • does not apply to am. owner of property who builds or improves thereon, and who contracts for - S,M.1 — - -,5.29. .•��y b3' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - - . Grading 20.00 . 11I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. 20.00 Date Owner Infrastructure 1.I698.86 WORKERS' COMPENSATION DECLARATION q,r'�•'. f:• I' hereby affirm that I'have a'certificate of consent,to;self;insure, or a certificate of .' Worker's Compensation Insurance, or a certified copy-thereof:'(Sec`'38,00, Labor Code.) Policy No. ,Comfiedpan ❑.Coy �:.. x ; is -filed with the cit O Certico pYiy. r py is herebyfumished..�; TOTAL S29621.41 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) *.r`.iliC:x. I certify that in the performance of the work for which this permit is issued, I shall not ' a ;., x<R i;'i i '; Tt1'F•�;. .g•X-�,Z. r-1 -employ any person in any manner so as to become subject to the Workers' Compensation _ Laws of California. Date __" 'Owner NOTICE TO APPLICANT: ll, after making this Certificate of Exemption you should become ZONE: • f BY: - subject to the Workers' Compensation provisions of'the: Labor Code, you must forthwith Minirnum Setback Distances: comply with such provisions or this permit shall be deemed revoked. - Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line `I hereby affirm that there is a construction lending agency for the performance of the. work for which this permit is issued. (Sec. 3097, Civil Code.) - Side Setback from Property Line Lender's Name Lender's Address This is'a building permit when properly filled out, signed and, validated; and'is subject to FINAL DATE INSPECTOR ' expiration if work thereunder is suspended for 180 days.' • I certifythal I.have read this application and state that the above information is correct., Issued by: Date Permit •I agree to comply with all city and'county ordinances and state laws'relating to building construction, and hereby authorize representatives sof this city to -enter the above -I mentioned property for inspection purposes. - • • • Validated by: Signature of applicant Date Mailing Address Validation: ' City, Stale, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ' IST FL. SQ. FT. ® $ 2ND FL. SQ. Ff. POR. SQ. FT. @ GAR. SQ, FT. ® CAR P. SQ. Ff. WALL SQ. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) METER LOOP GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB FINAL INSP. SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL REMARKS: SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING .. UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE PLUMB. OBONDING HEATING (ROU d STORAGE TANK FORMS �pROUGH -'tSEWER OR SEPTI FA ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. —Plus—X$—=$ LUMBER GR. FINAL INSP. (� FRAMING JC FINAL INSP. ROOFING /O /].lJ D EvJ `�. /� �i[ti t �v l — ✓ � ���. 6!' 7' C P1 t REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL OF ttal SCHOOL FACILITY FEES - TO: City of La Qui nta DATE:` k �} :Department.of Community Development'-'. ;•y . - ^78 105,.Calle Estado NOTIC°4 tM :•� Mi.; .+t S':{'..14`,^r tf .; - j Tk :; , 2 }:.3:• r ��/, I�7,'��$aUMEN '"• '-n^y l �.• �. r + TQId.' �j � _ •-;+, ^, .:_. .� � NOT h (.;; h:- e- ♦ - . ^a', s r •F c7--.ew-��w. A ! e.•i•Y•'' c�. ���' 3 ri� - .^•a*-. ii. �u.• •+{C'. `'", .;;h•, � Sl. .�• .��yc:. . * �, .>y-,�-�:�F`'i� - �l.F. -� '.J` fir: • ;�r ^✓ 't +5.. s r'. '�J,. -.ti _.. f�i'�.'k � . ; ff.r"`8;�.- � ® r �n.� -` < ._} 9'. • ,4, g"If �,v .i.w w + �i ^'>` •. t.. -C,`p: q' r .° I,yFC J.. �: r :•. AT ,:' u,+ t, . ED. • ' r .:.' ..,. a '-nw-. ',t •� � r � iv a..:.a., 1Y �,}'- �`,t' '} ' �,,1 tT+ '�3; vV .'+p� 9 }� • "a � ' _ .�� wd'r;�.. l.J • t. \u, r`�.24 Y i. •.l : .,?v`�"� .,..k> a�,r3 :,F.��.. x'; i •4t':.,, .r � , .t` .C+K•. �1F- .) . N`�,v tj�r- d-�if •,•��t �, ,•�. ... ."� .g• :if°`�t'l�,rr.-�.'te''' ie!i��1�.. .*5.. „i,';� - - •.'F«_k+".r i. '4..,.t''d r...t+,:, .a' . t r +ER y"i3S?: ; a�(^ .o�iMr+� , tar.f� f dd,. art. 1 e� H, eY ,t. .S�.�X^'G l..i. t'- L:.; ,•se y. y{:: .•�y..�A - .... y'?gThs:,isto. ertf ,.xthat .w•-.r��. •Oc. �0' Mtit �'� 'A) r!;t. �r,t -- f.r Thc.• '�':'+.. J aF :.L�•'!r - �,�. pp ''$•�r j��: A.$•' .':�(: _.v:. `'�R„��.. "n ��., 9ra. _'.�. -";3 .rte, 'w. r '.R .•w j'i developer• -.of_ ,:which Ql.s, /;,>�''L� .�'y �}•l�..� �' ••�. _ f y w.• •, •-.s..,�.' 7•'�,<''.? rs', s .M�.� :t. :,,K. - • ,;{..µ a.: f �•� 'r. ,:f; ...,y 3.. 'rE:. t �� .�bw�h••..-; -• �f cated;,at'�'' r ��3 � KGs �=/ .o.• .•�,�-�, wYthinu. =,,; iF t� t, ' f f• d .r . f, A,"x F- w. •• `.« - ' fi°i3.,"r,' *^....lsv+ 7•.'^w.r _ _ - ,y, ,e, - �`r• :s.._ . ., s� + t.,'. w ,.: f. ,th s pistr,ic�.t, sy a d�,,,Kgoo �Yc acil'i.t. , fees • osed f1,u uan't. ;}^ * e; t t Y-•�S'' % p i +4.,.a�`'•`.�,. ,. W, r1, � n. _.� 4i_.e. "'j'v .,y,#SF�d rvi.v.E ,,,.i*T�c3n :.nR"C+,o .J�npv.+�J�r+-,. 7yT 'd'f �. i� �j � t,if authority genera b ov rnme'nt Cod Sectio r� 53080 -in t e amou t'o 7f �7 P ; covering a total f "-�S� 'Kj "square feet of ( resideilitkaf or - ( ) industrial/commercial development and that building permits for [his footage in this development may now -be issued by your jurisdiction_ OF HCE OF E. LEON SPAUGY + AGRICULTURAL COti1f�115SIONER Eos +15=+o.` /� �� rl JAMES O WALLACEL 0 O AND, AGS+STAM CONINUSSIONEV ^(L In j WEIGHTS I•S b. MEASURES CLEMENT BENVENISTE SEALER — •" 49-613 Ilwy 86, Suite '13-12 Coachella, CA 92236 q Y p t 6q 619-342-8291 DATE Z ' Z aj' •.. % i 8 g' CASE NO. S 1? 5 0 1.29!A DEVELOPER'S NAME: X15.(.. a.► _ �- ADDRESS: _&Ann A . _ TELEPI [ONE: 7si 0 Dear Developer: After reviewing your landscaping plans, all plant"material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ fran plant material, listed, . this office must be notified humdiately. Thank you for protecting and preserving the Coachella Valley's pest -free environrr-ent. Agricultural Ccunds`siotAYs Office cc: Indio and Riverside Office i MADLIN'S ENTERPRISES ENERGY BUDGET 3 MANAGEMENT CONSULTANTS P. 0. BOX 1443. - PALM SPRINGS, CA 92263 (619) 324-1731 1 1-11 ti PRC )Pi )l Ei) RESIDENTIAL PROJECT HAS BEEN REVIEWED F'( -)H' C(-)riPLIANCE WITH THE. STATE OF CALIFORNIA ENERGY C()NSERVA"f ION STANDARDS REVISED TITLE 24 BY MADLIN'S ENTERPRISES. THE BUILDING. DEIGN DESCRIBED. I.N THIS 'CUMPLIANCE PORTFOLIO IS -IN SUBSTANTIAL CONFORMANCE WITH THE. STANDARDS`..,. JOB NUMBER: 10696 DATE: 06/09/86 -PREPARED FOR: BAY SHNDS CONSTRUCTION CO.. OWNER: 2.A'Y SANDS CONSTRUCTION_ CO. i PROJEC`f":' SINGLE FAMILY RES PLAN r i 6 -CT LOCATION:. _A QUINTA i METHOD OF COMPLIANCE:, POINTS CALCULAT I C-': ORIENTATi N OF FN1RY: NOR fH•. • , i Cat4al LiceiisesE #r 431975 I C 1 fG E... C P.. � i Form 3. M�atan .. r c &110L" NEAT TRANSFER COEFFICIENT MADGET 'Intl qe2w PROPOSED CONSTRUCTION ASSEMBLY CGNSlJlT41V TS List of Construction Components. .R STUCCO .18 ' i TNSULATION WITH RESISTANCE= 5.60 1 3. I.NSULAT I ON WITH RESISTANCE= 11.00 . 2 4. GYPSUM BOARD: .45 3 6. 4 g. l 7. Inside Surface Air Pilm .68 .68 cooling heating Sketch of Construction. Assembly Outside Surface Ai? Film '25 .17 WEIGHT:1.5 — 2 S Ib/ft2 cooking heating Check one: Total Resistance Rt, 18.06 17.98 Wall � cooling heating ' Roof uvalue II/Rt), .. 0 5 5 .055 Floor- _. ' cooling_ heating, W-: 4-. { ` i Form 3 w�ecooncs, - � aawa sari - • L+�IM- D�•WMl.1. wsst'vo.w HEAT . TRANSFER COEFFICIENT' ' MMET �dl Ot t PROPOSED CONSTRUCTION ASSEMBLY ' COAtSI�TANTs. . R` List of Conatnliction Components 2 ,. INSULATI:ON WITH RESISTANCE.= 38.00 11. z: GYPSUM BOARD OR .TILE . 45 3. 4:. Inside.Surfam-Air Pilm: ,_,9 2 .61 tooling;, hosting, Sketch of Construction Assembly • WEIGHT: 0 —15 Outside Surface Air Film .25 . 1 Ib/ftZ cooling. , hosting. Cheat one: Total Raietana.Rt. 39.62. 39.23 Wall cooling. heating. `. Roof X U•value II/Rt! .025 ,025 ' . Floor _ tooljng. heating ' i - R -G } 5 - LOAD CALCULATION Af11RAE METHOD ' - HEATING,EQUIPMENT SIZING COMPLIANCE FORM Page 1, of 2 FAY SANDS CONSTRUCTION - JOB NO. 10690 PLAN B --ENTRY TO N� ,RTH - LA VU I NTA ' SINGLE FAMILY RESIDENCE - SINGLE STORY* ---------------------- , :(plan check/permit #) ; Location Data: Palrt, Springs. ;----------------------; " (-checked by) ; Fui.lding Type: Single Family ;. Documentation Author (Serial # DEMO): "----------------------' (da.te) ; MADLIN'S ENTERPRISES' P.O.. BoX 1.443 - PALM SPRINGS, CA 92263 ;______________________; 61.9-3-24-1.731 Enforcement Agency Use Method: ASHRAE Load.Calculation.Manual --------------------------------------------------------------------------- Date: JUNE 6 1986 HOURLY HEAT LOSS Total Conditioned Floor Area:1424 spft Site Info.rmat'ion: Inside Design Temperature 70.0 F Outside Design Temperature 31.0 F Design Temperature Difference,: TD: For Standard AsseT:bl_ies 39.-0. F For Floor over Vented Unheated Space. 1..9.,5 F Conductive Heat Loss Description of Assembly Area. ------------------------------ ---- U -Value. ------- TD Btu/hr ---- ------ Slab, R- 0.0 16'deep 197.0 (f t) X 4�. 0' = 82.74 • Ceiling, R-38.0 1424.0 X Q`. 026 X 39.0 = 1461. ' Wahl, R-16.5 1335.0 X 0.061 X 39.0 = 3155 W Glazing, Double 21.0 X e.650 X 39.0 = 532 N Glazing, Double 91.0 X 0.650 X 39.0 = 2307 E Glazing, Double 77.0 X 0.650 X 39.0 = 1952 S Glazing, Double 52.0 X 0.•650.' X 39.0' = 1318 . SUBTOTAL. 19000 HEA•TING.EQUIPMENT SI.ZING.COMPLIANCE FORM Page 2 of BAY SANDS CONSTRUCTION'- JOB NO. 10690' Building Location.Data: PLAN B - ENTRY TO:NORTH --LA --------------------------------------------------------------------------- VUINTA Palm Springs .. • Infiltration: 142,4 X 8.0. X 0..5 AC X .0.1.8. X 39.0 = 3999 Conductive Heat Loss (From Previous Page): 19000' ' SUBTOTAL 22999 Duct Heat: Loss: 0.15 X 22999 = 3450 TOTAL HOURLY -.HEAT LOSS 26449 Ma:: imam. Btu/hr: 1. 3 X: C: 26449 + (10 X 1,424) 3 _ 5895 MINIMUM HEATING EQUIPMENT OUTPUT: 26449 (Btu/hr-)- MAXIMUM HEATING EQULPMENT OUTPUT:, 52895 (Btu/hr) COOLING EoU I PMENT SIZING COMPLIANCE' Fi SRM Page 1. of . RAY SANDS CONSTRUCTION - JOB. No. 10690 ----------------------- PLAN E' - ENTRY TO NORTH - LA- UUINTA ; SINGLE FAMILY RESIDENCE - SINGLE.STORY I(plan check/permit #) ' Location Data: Palm Springs ; -----_____ _ ____ ----- ' (checked by) Buil.ding Type: Single Family , '------- - --------- Documentation Author,(Serial.# D-=Mo)r ; (date) ' MADLIN'S ENTERPRISES P..4. BOX 1443 - PALM SPRINGS, CA 92,63. 619-324-1731 Enforcement Agency Use ' 'Method:- ASHRAE Load Calculation Manual Dater JUNE 6 1986 HOURLY HEAT GAIN Total. Conditioned Floor Area: 1.4 4 sq�- Site Information: Inside Design Temperature 78.0 F Outside Design Temperature 113.0 F ' Daily Temperature Swing 35.0 F ' Design Equivalent'Temperature Di`ference, TDeq:- Standard Temperature.Difference 35.0 F For Frame Walls and Doors. 28.,0 F For Masonry Walls 21.0 F For Floor 20.0 F For Ceiling and Roof 49.0 F iConductive Heat Gain' TD or Description of Assembly. ----------------------------- Area ---- U -Value ------- TDeq ---- Rtu/r- ------ Ceiling, R-38.0 1424.0 X 0..026 X 49.0 = 1t�_ Wall, R-16.5 1:335 : 0. X 0'.061 X 28. 0 ' _ 5 W Glazing, Double 21.0: X' 0.650 X 35.0 = 4- N Glazing, Double 91.0 X 0.650 X 35.0 = 2C7' ' E Glazing, Double 77'._0 X 0.650 X 35.0 _ 17__ . S Glaring, Double. 52.0 X 0.650 X 35.0' = 113 SUBTOTAL 9.5 COOLING EQUIPMENT SIZING COMPLIANCE FORM Page 2 of 2. BAY SANDS CONSTRUCTION - JOB NO...10690 Building Location Data: PLAN E - ENTRY TO NORTH - LA QUINTA Palm Springs ---------------------------------- Solar Heat Gain: ------------------------ ------------------- Description of Assembly. Area S. C., CLF Btu/hr W- Glazing, Double 21..0: X 0.66 X 78, _ 1081. N Glazing, Douole 91...0` X 0.66 X 34 = 2042 E Glazing, Double 77.0 X 0.66 X 78 _ 3964• S Glazing, Double 52.0 X 0.66 X. 51, 1750 SUBTOTAL 8837 Less: Sash Factor 0.00 X 8837 = 0 Net Solar Heat Gain: SUBTOTAL 8837 Infiltration: 1424• X 8.0 X 0..5 AC X' .018 X 35.0' _ 3588 Internal Heat. vain: = 3000' Conductive Heat Gain (From Previous Page): = 9584 SUBTOTAL :5010' Duct Heat Gain: 0.10 X 25010 =. 2501. TOTAL SENSIBLE HOURLY HEAT GAIN X7511, Latent Load: 0.20 X 27511 = 5502 SENSIBLE COOLING= LOAD: 275,1,1: Btu/hr TOTAL (SENSIBLE + LATENT) LOAD:, 33214 Btu/hr .(. 2.8 tons) ..��F�,�r• � A ►'� ,tis; :R/J�."�4'�i'��`I'i^'4i j�-^`_.��`�..,r : � , .. : � ." : ... -�' :."T w '`•` ., i'. � � s 1 �il'ri`�:: •-:�Tt,�•+�r,ff� D Z O H U W cn fr Z O U W U) U) `1 Q W Ir COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM ,77- 013 Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc) ,5;'R 22 (fo4,75-7-,e41,G7-16.c11 C40 Mailing Address 2y7- �F TAAPal-rL kAl City r M 4)4 S State Zip Code Telephone 1 3.22 --P.44 .Job Property'Address/J. rs— C -IA Description of Property (Lot. PM. TR) ,lJ;i 3�,✓7,.'T Lk ,.53— 76--T- 0,6R9 0 J •v L s9 L Liv r,� Ldor / ..3,4< aO� AJ /7- /9 *Assessors Parcel No epG)'r well C�7��L ('/4 /j/J ,j '` / use of Permit s +� b'/f � � Punning Case # Lot Size 7 /� YQL1:E: y SFD. MH Site Preparation Etc _ Signature f Applicant Date // 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE / Initial Date ,{ Certification Existing S.D. System ❑ Yes b<"- , JL- •' / U of required. WOCB Clearance required. ❑ Yes p No-,-"/ Soils feasibility report required. ❑ Yes a o Special feasibility boring report required. ❑ Yes © No Detailed contour plot plans required. ❑ Yes LTJ No Staff Specialist approval required. ❑ Yes ED No Lot Inspection Date Soils/boring report byc /� �� Project # Date Solis Map Page Soil Type G Approved by /wv' - '' Date Type of System: No. of Bedrooms (1) SepticTankSoil Rate Required ❑ Existing Ltid'New ❑ Additional ❑ Replacement 3 /^yG�jC ZmGals. (2)each line sq.' ft. • (Bottom ch area) Sidewall allowance ft. rock/ --Sq. Ft. Install Line(s) Ft. Long, Ft. wi a th. in. inches Lac *bed Sq Ft.-of bottom.4— per running ft. 9,N/A rock below drain lines area� ` � r Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI / Seepage Pit total depth r ApplicableT� ✓ ,' �• (� 7 Max. allowable depth N/A Overburden factor ,, /' / ��Y� �� t�rLtLC.! Y+ %�'-�' i►, ii ��d L�ia#��'•!/ja�Gfl+t This application i4:4rove €bred -for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building perm1t�s necessary for the install/�lltatio1nn,of the above de.sig,n�ed-�sIystem. Septic tank and sewer lines must bq,50' from any wellsl_ ly e,.� ej, i (2),+ Leach lines must be 100' min. from any wells including expansion area �. l fl' �y Seepage from i -1/0 be 15/00'' pits must minany wells cluding expansion area, C, u•zti(2� ✓1 cu ✓I o Signature of Health Official I,�tDal RECEIPT NO._ 3aL�'U Issued by -54 1// Date 3 / b District: ❑ Riversidendio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev 8187) A . -C