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12510 (SFD)t 440 P.O. BOX 1504 Building 1-440 Ramirez 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Sterling Homea Mailing Address p,®• BOX 450 City Zip Tel. La Quintin, CA 92253 564--1866 Contractor Lendel Ventures, Inc.: Address P.O. Box 450 City Zip Tela La Quinta, C1 92253 564--1866 State Lic. 63$3 City 859 & Classif. Lic. # Arch., Engr., . Designer ,Trb iria & .Associates Address I Tel. City . Zip State Ban Diego, CA 92119 Luc. # 013333 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of'Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 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,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 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 Division 3 of the Business and Professions Code, or thathe 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). 0 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 Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 e 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 L Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or 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 ateMailing Address City, State, Zip No. 12510 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 773-083-010 Legal Description Lot 25 Block 66 Project Description SFD F Sq. Ft. 1586 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter O Repair ❑ Demolition ❑ Permit does not include block walla or pool. Estimated Valuation x+96,626.00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 273.81 Const. 626.00 Mech. 49.00 Electrical 131.89 Plumbing 144.00 S.M.I. 9.70 Grading 20.00 Driveway Enc. .00 Infrastructure 2,135.84_ TOTAL s 39 • REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line nI e 5ac ron PropHi Line • FINAL DATE Issued by:— Validated by: i Validatilon.i a CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE � BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE Z —!3 �r DRAINAGE PIPING CAR P. S0. FT. ® GROUT I WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. BOND BEAM WATER SYSTEM FINAL URINAL SQ. FT. ® =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ / _ / �, N ROOFING [ ( WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSPECTIONtv 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 DERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE Z —!3 �r GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL FINAL INSP. yy�g GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING C(l n / _ / �, N ROOFING [ ( REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING �2 -,2 —t? i 6✓ MESH INSULATIONISOUND I FINISH GRADING FINAL INSPECTIONtv CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL • Qttw P.O. BOX 1504 APPLICATION ONLY Building 51440 AVE. RAMIREZ LA QUINT Address A CALIFORNIA 92253 Owner STERLING HOMES Mailing Address P.O. BOX 450 City Zip Contractor LENDEL VENTURES, INC. Address P.O. BOX 450 State Lic. & ClassifB 638535 Arch., Engr:, Designer , URBINA & ASSOC. Address -6370 ANVIL LAKE AVE. BUILDING: TYPE CONST. OCC. GRP A.P. Number 7-�3-0 Baro Tel. (6 19) 564-1866 Legal Description T Om 1 S RLgC_g f_ 6 Project Description SFD el.. City Lic. # 859 Tel.. CityZip State SAN DIEGO Lic. # C-13-331 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divisioo 3 f the Bu I ess arb o essions Code nd my license is in full force and effect. L�:IVU°3;L �J`�1V1�i1 5I INC. SIGNATURE DATE Ej. Y. 1JWd A R-8 ILDER d9d(A'WATJION I hereby affirm that I am exempt from the Contractor'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 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 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). I-; 1, as owner of the property, or my employees withwages 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. 1 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 buildsorimproves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 7 1 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 F] Copy is filed with the city. ❑ Certified copy is hereby furnished. 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 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, 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 BUILDING DIVISION Sq. Ft. 1586 No. No. Dw. Size Stories Units - New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. ♦ 00 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL IL 50 • D REMARKS 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 DP Issued by Validated Validatior CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @ $ 2ND FL. SO. FT. POR. SO. FT. @ GAR. SO. FT. 0 CAR P. SO. FT. G?; WALL SO. FT. SO. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEGUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEM(PERM 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'A c SEWAGE DISPOSAL SO.FT.GAR @ 3/4c HOUSE SEWER REMARKS: VENTILATION PERMIT FEE —, PERMIT FEE EEIEGASPIPING EE 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 ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEGUIP. 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 DESERT SANDS -UNIFIED SCHOOL DISTRICT S S c7 AcJ�' . • - $2 879 Highway;111 � I � -NOTICEc . 'Indio m ; CA 92201. Docuentr Cannot Be Duplicated 6197`:775-3500 : Date 11/29/93 TypeofPermit La Quints No.. 12546 :: Permit # Log Owner Name Sterling Homes. No: ` Street` See Below city. La Quinta: Zip 92253 Study Area 113 APN.#:. :Tract..#- Lot # S,quare Footage 14758 Type of Development . ,Siiigle Family" Residence No. of units 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 `mol ilehomes.: It has been determined the above-named owner is exempt from paying school fees-�at this' time due to the following reason:' ¢ `: EXEMPTION NOTAPPLICAIBLE This. certifies that school_facility fees iiriposed_pursuant to Government Code 53080 in the amount of. 1:65 X, . 4 758 `' or $ 7,850.70 have. been paid to D.S.U.S.D. for the property-listed,above and that building permits`and"/or.`Certificates of Occupancy for this square footage m'#his proposed project may now be;issued. Fees Paid By Sterling -Homes "Telephone 564-1866 Name on; the "check. By Dolores. A.' Ballesterosti, - Superintendent Fee collected /exempted by Vickie j :Durrett Payment Rikeive_d Signature 1 Check "Nad`=1698 . t' r Collector: Attach a copy of county`or city plan check application form to distnct'copy'for ap-waivers. Embossed Original- Building Dept./ApplicantCopy- Applicant/Receipt Copy - Accounting _ � REco4O1N0 REGUE6T[b a- .O M E 11.6': LLI � (31 00 ° . U. I U. • . AND WN[N.R[COROrD NAIL TO yp oUJ Q N w Translet Y>ir �' a NAM. Sterling Homes Oac COt�F.t�IY A B AOO^"' 8361 Vickers., Street � 1,'308 , WIL'LIAM E: • Idol t W `aT San Diego, Ca.:9:2111 Riv ' 8JV THIS I INk trOR RECORDICR'8 U8Lr IIA14'.TAX OTATRM1IYH Yet WWI! Ano ass SAME AS ABOVE C,Tv h STATIC L~ , q•. 7 7BPACF A Documentary tren�ter tw>, 3 4G.20 t" .................................. ✓C " Comli'uteif on. fullx:yalue;.of• property vonveyed, or Q Comliuted on (tilt,value.less liens, S enctirnhranc.6 reRtoininl' titereonlatttllre OI ><ole. J' .. ......... ............ Signature oaf declarant ar.,srtnt+,lotermining tax • firm name Q >llnin�or•liorated areae ' City of ................................. rAkttt. No Grant Deed •This form furnished by'Orange Coast Title Corimpany FOR A VALUABLE CONSFDERATION,'re.ceipt of 'which is.hereby acknowledged, . F`RANK_STRISKOVICH and'STEPHANIE-STRISKOVICH, husband and wife.' . hereby GRANTS) ao STE9LING HOMES, A, CALIFORNIA GENERAL, PARTNERSHIP the following described real property in the City. Of . Lai QUinta county ou ,.Riverside ,slate of.Gslilornia ��Lo4t�-15'yf�aond .1G in Blck 6 of .Stento Carmelita at Vale La Quinta, Uni t• No. h, in �Cf La Quints, as shown by Ptap on file in 'Book 180 page 67 of Maps, Riverside County0.Records. ' {4 Doled, January 7,% 1993 / STATE OF CAUFORNIA,. ). FRANK STRISKOVICH County of Riverside j K On January 7,; 1993 beforo,mo, tho.under- . signee, a• t P 41 c r. axl ;State, •personally SI NHANIE _s R�I'SKOVIG eppearodYSicC%IC'anc� STEPW fff7STRISROVICH personally known to 11e or proved to ma on the basitof satlefactory'pvidence to be ehC Rtrltu�is�whoSO.tu►me s) Ia/arasubscribed to the within instrument FOR. NOTARY .SEAL OR STAMP and acknowledged lo,'rno• that he/sheh*; executed the 'Same:in his/her/their authorized limeit,Y.Qls):_and that by:his/her/thei_r pIj natule(0 on the instrument the: non s)• or the entity upon behalf of which the per- jqn(s) acted, executed the instrument. :dr OrPICIAI. ItOTAPY SEAL J<1ME Ft?I, WAN ' Ijtv �ti a , , �. WITNESS my hand and otlicial seal.' J q`y,�. 0/ Corr -rte !:Nf) JI IL 17,1!)SJ5 Signature ! / J i r r,-a..o v,.+...v,,...., ,, ..,...., ..,...,. ..•.,,, . Title Order No. l;:rcrow`ISo. MAiL TAX-:6TATEMlrNT6 A6.:;,':DIRECTE0 ABOVC.j.' SO *J £t T L' 09S 6 T 9 3NvWAvN DN I IN31S COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No. ` DEPARTMENT OF ENVIRONMENTAL HEALTH 773 —D�'- — 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 list. A non-refundable 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 fora period not to exceed one year from date of approval. �0-..��, .1:.:59001 LOG # O t VERIFY ITEMS IN SECTION'A FROM A NON -FEE BUILDING & SAFETY (goldenrod)!APPLICATION $15 erson Agent, Cont o, Co!r;a3_ Phone Address City State INo Zip _ 1 Q"S / AAC, �L U. 80 K 4S b 6.:j/ 07%9$ sm r Phone L�'l � Address City State Zip .n 430 Z CA 9-7Z s a AJ -4 l!/ 7"A . Job Property Address_- CityState Zip Legal Description Prop. (PM, Tract, Lot) l-k)`G �UF-�l!/.ia�4ai2�L �A `iN�tiTIJ (A. 9.a.�,3 10T /�BIUC�i!�� Sidra �A?�+4t T4i Lot Size Water Agen -ft'Use of Permit PIP, CU, etc. Other 4r�lE �Aiii�✓`4 r D4cNFtlA (�cIGcF '— .� ' _---- li✓gW L f�_ I g"MH Site Prep etc. 30, Signature of cant Date CATEGORY ; REV CODE FEE CATEGORY REV CODE FEE 8111- UBS FACE DISPOSAL (per syate}') 1238 153.00 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 ❑ MU IPLPARCELS WITHIN SA E LAND DIVISION (NO PLOT PLAN) 1 ❑ 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 ConJucUon with Critical Area 7348 .' $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7348 $ 85•00 ❑ COPIES (LAND USE) 7786.81 $ .50 IN/TjIAL DATE /o/ 93 Holding Tank Agreements Completed ❑ Yes �✓ ii, 3G ' Certification of Existing S.D. System Required ❑ Yes ❑3 .. WQCB Clearance Required ❑ Yes CSO 0 (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes ❑ �NNo/ Special Feasibility Boring Report Required ❑ Yes Q''No" t6 Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes 2mo Grading Handout Provided ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes VN/o Maintenance Booklet Provided ❑ Yes Lot Inspection Dat Initial C/42 / Soils Percolation Boring Report by Lk/Project # Date Soils Map Page Soil Type [ Approved By Date - No. of Systems Type of System(s) No. Dwelling Units(l1 (1) Septic Tank Soil Rate Grease/Send ❑ yolding Tank ❑ Replacement ®'Frew ❑ Addition Bedrooms, Fixture -Units, n Gre I top/UntTrap ��(��R , Gal. A 3 �Y Gal. ❑ Existing Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. ottOm Area tt. rock/ sq. fl. per running ft. Inlet Tested Depth Inste�li Une(s) ft. long n. wide wtth min.- - n rock below drainlines or ottom Area Proposed Bottom Tasted Depth Leacromea/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total SeepN o?/ Depth ',Other:— Appuceble Inlet (BI) (TD) 0? Max. Allowable Depth - �� L$F& ©' 6 I 1 r N/A Overburden Factor Y0 Well Review Approved: Signature Date Well Drilling Permit # Grading Pian Approved: Signature Date REMARKS: This application is A( PPROVED/ NIED,for the category checked In SECTION B above, regarding the design of a subsurface disposal system as indicated on the acc_ otpanied plot Ian, using the uirements set F=ION,.C,.ebo building permit is necessary for the installation of the above -designed System. tin construction to narmraea rn the mquired rasarvari iiluwn aYpaDsiDn�r,�a (1J Septic tank must be 466minimum from any well ley/,,,� 1� ,.�P (2 Leach lines must be 100' minimum from any wells, incl dJ ing Vtansion area 033 Seepage pits must be 150' minimum from any wells, including expansion area a' /(//�•G %�P-�' VW44.1 , cLi..,. U-30- 93 Signature of Health Official Date ,) /n ❑ CASH { ❑ CHECK NO. RECEIPT NO. Issued By v{1 W�� Date DISTRICT: ❑ Riverside P-Inditr ❑ Hemet ❑ Perris ❑ 'Rancho Calif. ❑ Blythe DOH -SAN -1 22 (Rev 1/92) DISTRIBUTION: WHITE --Office file YELLOW—Applicant PINK—Bldg. Dept. , GOLDENROD—Plans/Records 64: ie 00 - An �.y �•,.e.-+-.aany-^v*a.c'-•P--v-+i,o..waFie:.F+-•.�:'-- .... -s ,4"� �-• '-- -^--- -- ,-.,•,�.�.r,��. a _ , �-r-',re�i�-p-T•vtnipy.�;,�1 . 7Q J: EARTH SYSTEMS CONSULTANTS S.C. BUENA ENGINEERS DIV. 79-811 B Country Club Drive 4 Bermuda Dunes, CA 92201 • (619) 345-1588 rr. - Client Name Client Address DATE TEST LOCATION 14461SC S JOB NO. PROJECT S/ LOCATION L "q Ou/U; '4 CONTRACTOR MOISTURE CONTENT OWNER -STF2 /�� iar WEATHER TEMP. o at AM ° at PM PRESENT AT SITE i��.✓ Sl yvo '4 • TES�vS NUM e: TEST LOCATION 14461SC S '—LST NO. ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE CONTENT DRY DENSITY lbs./Cu. ft. MAXIMUM DRY DENSITY % MAXIMUM DRY DENSITY IbsJcu. ft. OPTIMUM MOISTURE CONTENT % i��.✓ Sl yvo '4 • 71 5.5 /03.9 yo .5 51-oy5 7.1 / 05.E 92 � �� �•`� /05.1 9/ L ✓TNI 7A 1(14 vA 9A 01 v ae O I vA n rf I I ' , I ( (J V I r3Utnlld�l 'flinr/IEZ REMARKS: Zr rT �-� s Ts �� 7#/-4 rI AIIS N Cllm oF.'o Ale -(IX Via. 9r0/5//F N / Uf /l Olaf` . /llf O Ai't IVA y. Zs 197- dr 961 FIELD REPORT CLIENT REPRESENTATIVE SIGNATURE 4TECHNICIANS SIGNATURE �p� 1� N? epi 6