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06611 (SFD)Building 51-734 Caciianza c&'�v u P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 T• Southwest U Itilmes s Inc - Address F. 0. Box 1353 City I Zip Tel. Contractor Address State Lic. City & Classif. I Lic. # Arch., Engr., Designer .. Address Tel. City Zip State Lic. # LICENSED.CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)t. of Division 3 of the Business and Professions Code, and my license is in full force and effec SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.Busiless and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also .requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of I Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis IiI ,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). .O 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.) ❑ 1, 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 Contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date f 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 ❑ Copy is filed with the city. ❑ 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 the work for which this permit is issued, 1 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 Ihereby 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 certity 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 J r.. No. 06611 BUILDING: TYPE CONST' - OCC: GRP. A.P._Number 773-125-011 Legal Description Project Description SFD Sq. Ft.1S6y Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $911108 PERMIT AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. $ 262,.65 Const. 603.50 Mech. 53.50 Electrical 113.161 Plumbing 157.50 S.M.I. 6." Grading 20.00 Driveway Enc. 20.00 Infrastructure 2,011.68 TOTAL $3,418.88 REMARKS �.x.- ,,j�t .qr, �•, r r,Acr c <0", • i;,0:l ! f.RA, .4 j r Y di1-((++�, # �T'll.. P 'i • .• Jn:"71cJ .; i! ZONE: BY: 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' FINAL DATE INSPECTOR Issued by: Date 10/31%89 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL SQ. FT. ROUGH PLUMB. BONDING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® FORMS GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS DUCT WORK DRAINAGE PIPING CAR P. I SO. FT. ® GAS (ROUGH) WALL SQ. FT. ® METER LOOP DRINKING FOUNTAIN SO Fr. ® OTHER APPJEQUIP. URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GROUT WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(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 ® 1% c SEWAGE DISPOSAL FIRE ZONE ROOFING SO.Ff.GAR ® 31'ic HOUSE SEWER FIREPLACE GAS PIPING PERMIT. FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE 111PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK 1;17 X-14 +, �jUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ljlg7 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK ` FORMS 290SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE �?If% , GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ -$ LUMBER GR. FINAL INSP6 FRAMING FINAL INSP. ROOFING V22- �Q/J /�jy/� - yy�� W)NOO•`` ' Vy REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING '1'/){' IV /MESHINSULATIONISOUNDOj I@ FINISH GRADING i FINAL INSPECTION / II 1 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 4 4v Qum& P.O. BOX 1504 APPLICATION ONLY Building78-105 CALLE ESTADO Address �' �� C�-�� Z`'¢ LA QUINTA, CALIFORNIA 92253 Owner / BUILDING: TYPE CONST. OCC. GRP. Mailing J Address 2 .., ..-- -- -7 -7 — 1-Y , n i f City Zi Tel. Legal Description L O 7 Contractor Project Description �- /` %, lc/�� / /i u r C Olt/ • CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tis section need not be completed If the permit is for one hundred dollars (E100) valuation vlus.) . I certify that in the performance of the work for which this permit is issued, I shall not employ arty person in any manner so as to become subject to the Workers' Compensation Laws of Cal'domia Date Owner NOTICE TO APPLICAW., O, after making this Certificate of Exemption you should become subject to Me Itbrkers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the wok far whidr this permit is issued. (Sec. 3097, Civil Code.) Lenders Name Lenders Address This is abuilding permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 1 certify that I have read this application and slate that the above information is correct. 1 agree to campy 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 REMARKS to a n x ren (lxJ) 47 T�r1TA1 <`�� 77r: At) I .. _. ZONE: BY: 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 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: City Zip Tel.. State Lic. 8. Classif. City Lic. If Sq. Ft. / S6 Size v No. No. Dw. Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 thereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 701q) of on 3 of the Business and Professions Code, and my license is in full force and effect SIGNATtnW DATE OWNEWBUILDER DECLARATION 1 hereby affirfn that 1 am exempt from the Contractor's License Law for the following reason: (Sec 7031.S,Busness and Professions Code: Any city or county which requires a permit to construct. afer, improve, demolish, or repair any structure, prior to its issuance also requites the appicard for such permit to rile a signed statement that he is licensed pursuant to Ore provmons of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of orison 3 of the fess and Professions Code, or that. he is exempt therefrom, and the basis .far rhe alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appica t to a civil penalty of not more than Ove hundred dollars ($500). air, a 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 Professors Code: The Contractor's License Law does not apply to an owner of property who brads or inproves thereon and who does such- work himself or through his own employees, poviled Mat such irproverrhenlsaere not/intended or offered for sale. n, however, the building a irprovanerrl srseld!wf0uh,one year,' ,(conptetiori.,tie(owner-builder will have the burden afprorehg Mahe d -d not buil or irprove'for the purpose of sale.) ❑ 1, 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 tinproves thereon, and who contracts for such projects with a contractWs) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt order Sec B. & P.C. for this reason Estimated Valuation PERMIT AMOUNT Plan Chk. Dep..'7 � Q _0 Plan Chk. Bal. �. 6 Const. �� Mech. Electrical Plumbing 1 S7 - Sb S.M.I. ' Grading - d ` Driveway Enc. Date /0/_1742/Af owner Infrastructure 'Z iGts L BOO WORKERS' COMPENSATION DECLARATION 1 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 Na Company - Cl,Copy is filed with the city. ❑ Certified copy is hereby fumished. q �� Y ` 6 0 TOTAL Z7 5–, 0 0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tis section need not be completed If the permit is for one hundred dollars (E100) valuation vlus.) . I certify that in the performance of the work for which this permit is issued, I shall not employ arty person in any manner so as to become subject to the Workers' Compensation Laws of Cal'domia Date Owner NOTICE TO APPLICAW., O, after making this Certificate of Exemption you should become subject to Me Itbrkers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the wok far whidr this permit is issued. (Sec. 3097, Civil Code.) Lenders Name Lenders Address This is abuilding permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 1 certify that I have read this application and slate that the above information is correct. 1 agree to campy 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 REMARKS to a n x ren (lxJ) 47 T�r1TA1 <`�� 77r: At) I .. _. ZONE: BY: 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 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SZKLR SYSTEM 2ND FL. SO. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. @ GAS (ROUGH) sj HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. @ TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. @ FINAL INSP. WALL SO. FT. @ WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. $ plus x$ =$ URINAL SO. FT. @ FINAL INSP. FRAMING 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 FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRY TRAY 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 @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ 3/4c HOUSE SEWER FINAL INSPECTION 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 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE 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 FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL zL November 15, 1989 Acct. No. 31082 American Engineering Laboratories, Inc. 58945 Business Center Dr., Unit A Yucca Valley, CA 92284 Telephone (619) 228-1754 FAX (619) 365-6908 San Diego • Corona • Modesto • Yucca Valley Apple Valley To: Southwest Living Homes P.O..Box 1352 La Quinta, CA 92253 Subject: In Place Density Testing Single Family Residence 51-730 Avenida Carranza La Quinta, California On November 14, 1989, a representative of this company visited the above referenced project and performed in place density tests. The results of our testing indicate that the embankment placed as compacted fill was compacted to at least 90 percent of maximum density at the locations tested. The maximum density was determined.per ASTM Test Method D1557 and the field density tests were performed in accordance with ASTM D2922. Please call this office if you have any questions regarding the above referenced project. Si erely, AM ICAN ENG EERING LABORATORIES, INC. G Paul oerstin Branc anager/Y PRH/bf ca\ Val ley AMERICAN ENGINEERING -LABORATORIES, INC. ❑ 7940 Arjons Drive, Suite A ❑ 1490 Rincon Street, Unit Z ❑ 515 Galaxy Way 58945 Business Center Dr., Unit A San Diego. CA 92126 Corona, CA 91720 Modesto, CA 95356 Yucca Valley, CA 92284 (619)695-3730 (714)272-4230 (209)576-0813 (619)228-1754 CLIENT: PROJECT: DATE: \\ — 14 - Zq rJ 0 U1 `r� W S''.. I.D. NO.: Ali 4// 51-� 30 �,:,zr� �b � caR;��ti,z� PROJECT NO.: 3 \ C3 a 2 - REPORT REPORT OF FIELD COMPACTION TEST TEST 4 LOCATION OF TEST TEST # LOCATION OF TEST \ l L:•i C \ \J t FIELD OPTIMUM FIELD OPTIMUM FIELD - MAXIMUM PERCENT PERCENT REMARKS: MOISTURE MOISTURE DRY DENSITY DRY DENSITY RELATIVE REL COMP. ' % % P.C.F. REQUIRED COMPACTION REQUIRED P.C.F. COMPACTION REQUIREDo i TEST 4 LOCATION OF TEST ! - OPTIMUM MOISTURE FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION FIELD OPTIMUM FIELD OPTIMUM FIELD MAXIMUM PERCENT PERCENT REMARKS: `,\\ MOISTURE MOISTURE DRY DENSITY DRY DENSITY RELATIVE REL. COMP. ' % % P.C.F. REQUIRED COMPACTION REQUIRED % % P.C.F. COMPACTION REQUIREDo i TEST # LOCATION OF TEST ! - OPTIMUM MOISTURE FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION FIELD OPTIMUM FIELD MAXIMUM PERCENT PERCENT REMARKS: \•�•� ` t� ;` ' MOISTURE MOISTURE DRY DENSITY DRY DENSITY RELATIVE REL. COMP. PERCENT % % P.C.F. DRY DENSITY COMPACTION REQUIRED REL. COMP. % % P.C.F. COMPACTION REQUIREDo i TEST # LOCATION OF TEST ! - OPTIMUM MOISTURE FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION PERCENT REL. COMP. REQUIRED REMARKS: FIELD OPTIMUM FIELD MAXIMUM PERCENT PERCENT REMARKS: \ •�•�� ;u0,7 MOISTURE MOISTURE DRY DENSITY DRY DENSITY. RELATIVE REL. COMP. % % P.C.F. COMPACTION REQUIREDo i TEST # LOCATION OF TEST ... ' FIELD MOISTURE OPTIMUM MOISTURE FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION PERCENT REL. COMP. REQUIRED REMARKS: .� So��wFSrt L��NG i��1MFS 51-'130 �vEN�Ok� C�R2t�NZ P. .Amert=n Eniancermg Laimmwries. Lac. 58945 Business Ccncer Or, Unic A. Yucm Vail v. CA 92234 OFFICE OF o_ AGRICULTURAL COMMISSIONER AND •:� WEIGHTS & MEASURES CALVIN C. KAMINSKAS JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Assistant Commissioner Agricultural Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE Director of Weights & Measures Sealer (714) 787-2561 49613 Highway 86, Suite B12• Coachella, Ca. 92236 %�"yl �� go in e ( 619) 342-8291 Sl 2Y 0 - Vt. &c —von jt 4 DATE �d L� J� CASE NO. DEVELOPER'S NAME: 7'h Gaead ADDRESS: TELEPHONE: 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. gricul,V6ral CcnTnissioner's Office cc: Indio and Riverside Office Q Z O U W m Z O U W (1)' X Z O U W U) W Z O U W U) COUNTY OF RIVERSIDE ENVIRONMENTAL Assewlil t P1111roN NO. HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as Indicated on the attached check Ilst A non-retundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Q4,C�f Agggt; 9ractor, Conta mon` ' YGt•5 Phone Address & Firm r . , Ow *4 AiiftHj /lmu � Phone Mailing Address f :5 ✓O!{� city State �f� Zip ��lri� Job �Plroperty Address 5/ Avc �••c•��, Legal Description Prop. (PM, Tract, Loot) Ung Lc'�Uiiti!!� 1 jo Lot Size Water -Agency l ell Use of Permit P/P, CU, etc. Other i r J %i ` ` (_ V JJ � ailing/MH Site Prep, etc. Ay f Signature of Applicant Oats CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE M SUBSURFACE DISPOSAL 1238 $ 57.00 .0 SITE EVALUATION UPON REQUEST 7349 $ 43.00 O MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00 a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 O Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) O Site Evaluation in Conjunction with O HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 O ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluatkm Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 INITIAL DATE �j Q Holding Tank Agreements Completed O Yes No, -,"A d - T t/ -0 / Certiflcatlon of Existing S.D. System Required[g< 1 r WOCB Clearance required. (Attach Form ❑ Yes No DOH SAN 007, Santa Ana Region Only) Sells Percolation Report Required. ❑ Yes Special Feaslbillty Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes o/ Other ❑ Yes � No Staff Specialist Lot Inspection Required ❑ Yes to Lot Inspection Date Sella boring report by project 8 Date 1 Soils Map Page[ Sal Type Cmc Approved by �" v" �'" ` Date ! G ' k/- No. of Syalems Typeof System(-) No. Dwelling Units 1) (1) Septic Tank Soil Rate Gream/Send O F ding Tank Exrsti ❑O R B roomhix rpts,.ith to QD�s, `+ p G Irrtc rJ a7 3r /e/ Gel G al `(2Leech Line Sq. FL h arae Sidewall allowance ft ftmin, lnstsll Lines) tL long ----ft wide with Leach Bed sq. ft. '%�boltom _ rock/ sq. per running ft. NA ache- drefnlines or — area " Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Tota+l Depth (TD) -�. t / Applicable f N/A Overburden factor A 1 Ly' 6 r Inlet (BI) Max. Allowablg Depth 1/0 No. 2 Systenyv/-4 REMARKS. This application i APPROVED EEhfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan' p n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. (1 Septic tank and sewer lines must be 50' minimum from any wells qr l G/�`',! �,tiu� �(�!�.,.„ 2. Leach lines must be 100' minimum from any wells, including expansion �8rea (3 Seepage pits must be 1150' minimum from including expansion areaN? �any /wells, �it! 1 Signature of Health Official �—f✓� ,� �C6'��^� /��e� Date ` RECEIPT NO. �/ Issued By Date— DISTRICT: ate DISTRICT: O Riverside, Indio ❑ Hemet q Perris O Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records r 5 r