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11350 (SFD)Building Address 51!585 Carra:nza P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 11350 Bar Con Development BUILDING: TYPE CONST. - OCC: GRP. Mailing Address 41625 Eclectic #H A.P. Number *773--124`817-8 ; Legal Description Project Description Lot 5 Block 56 Tnit 5 BFD City Palm Desert Zip 92260 Tel. 773-9024. Contractor Bar Con Development Address • r s cure City Zip Tel.: a State Lic. City & Classif. B1 564202 Lic. # -1-112 1.4 Sq. Ft. .1606 No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address , Tel. .x PerJAit does not include block Wali or nodi City / Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am Ilcensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of t`he,eu_siness and Professions C�e, and my license •. i In full force and effect. `-y'^ �+? -1 % k 92 SIGNATURE' 1 A '� - DATE \;j " OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors Lirense Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city'or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to 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 the alleged exemption. Any violation of Section 7037.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). .. ❑ I, as owner of the property, or my employees with wages as their sole compensation; will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work hirrsell or through his own employees, provided that such improvements are not intended or offered for sale. If, -however, the building or improvement is sold within one year of completion, the owner -burbler will have the burdenr of proving that he did not build or Improve for the purpose of safe.) . , Estimated Valuation 95,_587.50 PERMIT AMOUNT Plan Chk. Dep.' s 250.00 Plan Chk. Bal. Q 8 3.80 COnSt. �t t 621.50 Mech. - 62. 00 ElcCtflCal - q ry A w p A �5 99 Plumbing 166. 50 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con slruel the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law. does not apply to an owner.of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason � S.M.I. L 9.60 Grading 2� Driveway Enc. 00 � {�0 Date owner Infrastructure 2088. 23 WORKERS' COMPENSATION DECLARATION R lA 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. 3800, Labor Code.) Policy, No. Company ��Copy is filed with the city. O Certified copy is hereby furnished. - - t a7= } Y A y! t ^f w r • 7 TOTAL 3630.02 1 3380.82 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. , CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the -above-. mentioned property for inspection'purposes. Signature of applicant Date Mailing Address City, State, Zip REMARKS ZONE: BY:- Minimum Y: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop: Line Side Street Setback from Center Line Side Setback from Property Line . i i FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: F CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. DRINKING FOUNTAIN. SQ FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING Cu. yd. $ -Plus-X$ LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL 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 PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADEtr/ ROUGH PLUMB. f BONDING HEATING (ROUGH) STORAGE TANK FORMS RE190 SEPTIC TANK/ OUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) o METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 A C ct FINAL INSP. ROOFING !j I�j� L� W•", 1 or l Q O �I 0 I >at l� LP ,� �-/� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LAWING (, MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION- ` CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL P.O. BOX 1504 APPLICATION ONLY Building �! �j �� C LA QUINTA, CALIFORNIA92253 '� Address / Ai�•Q,A tJZA Q� Owner , oV Co ?' BUILDING: TYPE CONST` OCC. GRP. Mailing _ Address �� ` fwzs+ SViTf- E%- A.P. Number City Zip Tel. 13.90 24 Legal Description Z-c�'i� %� Rts--i ' kc_ .� �a S •�• �� Contractor Project Description ' ? • �. Ax._ P,- CD Address I City Zip State Lic. & Classif. 164— 5(04 Arch., Engr., Designer Address Tel. City Lic. # ' 2_%`�X Sq. Ft. Size New el. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) oDivj ion 3 of Ft Business apQ Professio_ ns CodPand Ir1� icense is in (u' force and effect. 1\ iXl s)+ 1 (!.� �1'�� p111 S GNA; I. T� DATE O NER-BUILDER UtCLARATION I hereby affirm that I am exempt from the ontractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to 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 the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I ' I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 1 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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. 3800, Labor Code.) Policy No. Company [I Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT., If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION //0� No. �Q KII Stories Add ❑ Alter ❑ Estimated Valuation PERMIT A0 — No. Dw. Units Repair ❑ Demolition ❑ G ??, c� AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. 2, 6D Electrical J29,& Plumbing 6 6 ,,s^ S.M.I. 17,610 Grading /l p, ATO Driveway Enc. nfrastructure 202?$ • Z�j (J'q. MY/V ` Y 7 t o( TOTAL REMARKS�1'i'R"4�'I'11T( ZONE: BY: Minimum Setback Distances: Front Setback from Center Line f Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE COLL. AREA NO. ELECTRICAL FEES NO. PLUMBING FEES DUCT WORK IST FL. SO. FT. @ $ p / UNITS• FINAL INSP. GRADING cu. yd. plus x$ s$ REMARKS: YARD SPKLR SYSTEM 2ND FL. SO. FT. @ O "I 7l/ MOBILEHOME SVC. BAR SINK POR. SO. FT. @ GAR. SO. FT. @ LLD POWER OUTLET ROOF DRAINS DRAINAGE PIPING CAR P. SQ. FT. @ WALL SO. FT. @ DRINKING FOUNTAIN SO. FT. @ URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL - FLOOR SUSPENDED 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. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c G6 SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.=PL.CK.FEE CONST, FEE ELECT. FEE SMI FEE PLUM .FEE HEATING & AIR COND. SOLAR A.C. UNIT COLL. AREA HEATING (ROUGH) STORAGE TANK DUCT WORK ROCK STORAGE HEATING (FINAL) OTHER APPJEQUIP. FINAL INSP. GRADING cu. yd. plus x$ s$ REMARKS: DESERT SANDS UNIFIED SCHOOL DISTRICT ern' 82-879 Highway 111 NOTICE: IIndio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 9/10/92 1 Type of Permit I La Quinta No. 111705 Permit # Log # Owner Name Bar Con Development No. 51-585 street Carranza city La Quinta zip 92253 Study Area 111 APN # 773-124-817-8 Tract # I J Lot # Square Footage 116W Type of Development Single Family Residence No. of units 0 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X 11.606 or $ 2,537.48 have been paid to D.S.0 S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Barcon Development Telephone 773-9024 Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Shelley D. Bennett Signature 1� Payment Received . Chick No. 006 Collector: Attach a copy of county or city plan check application form to district copy for all wzuvers. i4. f YjEmbossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting ; ; CALVIN C. KAMINSKAS Assistant Commissioner (714) 275.3000 OFFICE OF AGRICULTURAL COMMISSIONER JAMES O. WALLACE, Commissioner 83-612 Avenue 45 Suite 7 Indio, CA 92201 (619) 342-8291 DAN RILEY Sealer. Weights & Measures (714) 275-3030 DA T `l � q, j CASE NO. P Q 0 !� Q DEVELOPER'S NAME: ,r`c'O,J F c1 c hjaL,. _- 4 ADDRESS :%U C-4, -C TELEPHONE:(W g ) 773 n Q z y e.4y-rA..► ZA /,LTA S 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 from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agri tural Commissioner's Office cc: Indio and Riverside 4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012 0 all Z 0 U W U) 00 Z O I— U W X W Z O F- U W U) N a � NTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No. LCOU �— ��'� —811-0 MEPARTMENT OF ENVIRONMENTAL HEALTH PERMIT APPL�ATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit thistform with four copies of a SCALED plot plan (1-20 SCALE) drawn to County speculations as indicated on the attached check list. Wnon-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. r pprovah of this application shall remain valid for a period not to exceed one year from date of approval. t� I LOG # VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION Agent, Contractor, Contact Pe on Z"p VN W Phone 401C{ AddressCity State Zip P&M (0 %a 6 111 q4 LA.?► Pjs ' „3-'%W W- 6'M E4pc_ ;'r- P• I> A q z Owner 4 ;-•i iL: Phone Address City State Zip CZ 2 e 9zZ6o Job Property Address City State, Zip Leg-gl 5sc1iptip Pro . (PM, ract _Lot) L.CT �7 O� Ga L•� U w .t` 54. -ta cus!'IN IA Fobk Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other ?A'Ge- (03 O (O G V Dwelling, H Site Prep, etc. C �:';'l 15 Z Si nat re of Applicant V Date CATEGORY REV CODE FEE CATEGORY REV CODE FEE SUBSURFACE DISPOSAL (per system) 1238 $153.00 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION (NO PLOT PLAN) ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 a. 1st 4 Parcels (Each) 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344 $ 55.00 ❑ HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑ GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 ❑ COPIES (LAND USE) 7786.81 $ .50 INITIAL DATE ( Holding Tank Agreements Completed ❑ Yes No Certification of Existing S.D. System Required ❑ Yes No WQCB Clearance Required ❑ Yes No (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes No Special Feasibility Boring Report Required ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No Grading Handout Provided ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Maintenance Booklet Provided ❑ Yes No Lot Inspection Date Initials 1 Ft C/42 / Soils Percolation Boring Report by f e Lic/Project # Date r Soils Map Page Soil Type Approved By /G t �0 Date No. of Systems Type of System(s) ❑ Holding Tank ❑ Replacement No. Dwelling Units Bedrooms,Ixture Units (1) Septic Tank Soil Rate d Grease/Sand Grease tcp/UntT ' New ❑ Addition ����, % 009 Existing �^ Gal. Al Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. Bottom Area Ft. ft. rock/ sq. ft. per running Install Line(s) ft. long ft. wide with of Bottom Area Inlet Tested Depth -•��O NA min. �inche_s rock,below.drainlines`ct"""^"�- ,z. -.-' 'Proposed e Bottom Tested Depth �m Leachlines/bed special design for slope: (3) Pit Diameter N0. Pits Pit Below Seepage Pit Total Depth / Other: Inlet (BI) (TD) /7 Applicable N/A Overburden Factor ❑ 5 ;K6/} 1 / , Max. Allowable Depth ?fi l / f Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date REMARKS: This application is/A PROVED/D NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompani d plot pla sing the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed syste o expansion area (1) Septic tank must be 100' minimum from any wells (2 Leach lines must be 100' minimum from any wells, including expansion area 3) Seepage pits must be 150' minimum from any wells, including expansion area Signature YA Health Official 11-�l of Date RECEIPT NO. 7576 L/ ❑ CASH CHECK NO. 00 ,7, Issued Byl - f Ai r� /rDate /3 V'? Z DISTRICT ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev 1/92) DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records t 2 Z O U W U M Z 0 H U W U) N Z O U W (D W Z O H U W CD .. . }... ..ter ` � 1 r,t ,..-t • . .:r'�' . % r "'rn�.Yr. � ,. , , � , , r- a `v ;OUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No. MPARTMENT OF ENVIRONMENTAL HEALTH 1—n3_12_14 — 811-9 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit thiorm with four copies of a SCALED plot plan (1-20 SCALE) drawn to County speculations as indicated on the attached check list. non-refu cable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. pprov,g of this application shall remain valid for a period not to exceed one year from date of approval. ' a7 —4 LOG # VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION Agent, Contractor, ContacLRerson M6 hN Phone (O%Ct Address City State Zip All P46 VA10a4(=-L,4► %," -Z `1'13 V y- - (oZs F, I> • LQ q Z Owner M +-4 V Phone Address City State Zip iJe ve -4113-yo 1-(oZS Job Property Address City State Zip Leg I D sc ip Prop.. (PM Tract, Lot) f Pc. luo CAAlkAmm L�► v ti -Ir LA � �.66o114 1A Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other pA,�e e3 O l G Dwelling, H Site Prep, etc. 31 15 L Si nat re of Applicant lu Date CATEGORY REV CODE FEE CATEGORY REV CODE FEE SUBSURFACE DISPOSAL (per system) 1238 $153.00 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 PARCELS WITHIN SAME LAND DIVISION (NO PLOT PLAN) ❑ MULTIPLE ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 a. 1 st 4 Parcels (Each) ' 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344 $ 55.00 ❑ HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑ GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 ❑ COPIES (LAND USE) 7786-81 $ .50 INITIAL DATE Holding Tank Agreements Completed ❑ Yes No Certification of Existing S.D. System Required ❑ Yes No WQCB Clearance Required ❑ Yes No (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes No Special Feasibility Boring Report Required ❑ Yes No Detailed Contour Plot Pians Required (1 to 5 ft. interval) ❑ Yes No Grading Handout Provided ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Maintenance Booklet Provided ❑ Yes No Lot Inspection Date Initials / C/42 / Soils Percolation Boring Report by / �' Lic/Project# Date / �4' (� Soils Map Page Soil Type Approved By 11001— Date No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand ' p Holding Tank ❑ Replacement j� New ❑ Addition Bedroo s, Ixture Units �t t 009 .411 Grease Greaselntcp/LInIT '�7 Existing J����� r Gal. Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. Bottom Area Ft. ft, rock/ sq, ft. per runnin -install Line(s) ft. long ft. wide with of Bottom Area Inlet Tested 0 h NA min. inches roc4 below.drainlin - ._- Proposed Bottom Tested Depth Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth 7 Other: Inlet (BI) (TD) /7 Applicable N/A �_ Overburden Factor ❑ 5 K 6 � / � &t Max. Allowable Depth 2� Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date REMARKS: s This application is PROVED/ NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompani d plot pla sing the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed o)ansmnn area syTLeach tank must be 100' minimum from any wells ines must be 100' minimum from any wells, including expansion area e pits must be 150' minimum from any wells, including expansion area Al Signature Health / '"� of Official Date DOH-SAN-122(Rev1/92) DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records v ❑ CASH C CCHECKANO. 00 RECEIPT NO. 75.,76 Issued By f [i ld� Date O / -3 Z DISTRICT: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH-SAN-122(Rev1/92) DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records