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374771, 08621 (SFD)BUILDING PERMIT PERMIT NO. DEPARTMENT OF BUILDING & SAFETY DST 3747711' 7 4 7 71 COUNTY OF RIVERSIDE FIELD r CONSTRUCTION ESTIMATE Job Address NO. ELECTRICAL FEES NO. PLUMBING FEES SpaceZip Owner UNIT$ ' IST FL. SQ. FT. @ '�+ 2ND. FL. SQ. FT. @ YARD SPKLR SYSTEM POR. SQ. FT. @ MOBILEHOME SVC. BAR SINK GAR. $Q. FT. @ �� Q POWER OUTLET ROOF DRAINS CARP. SQ. FT. @ Date - Dist. DRAINAGE PIPING WALL SQ. FT. @ Micro Film Fee Cop' $ DRINKING FOUNTAIN SQ. FT. @ • 0/vc �• «��''^^ �} C- ?t1-3-6. .� Parcel No. URINAL ESTIMATED CONSTRUCTION VALUATION $ Mech. Fee Dbl $ WATER PIPING NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN MECHANICAL FEES cks S SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER +� GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED P YP LAUNDRY TRAY AIR HANDLING UNIT CFM $ IDLE METER KITCHEN SINK x ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET 1 COMPRESSOR HP TPlumbing Fee POLE,TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY Pion N`o•. AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. @ C BATH TUB -Sp. Insp. Fee $ SQ. FT. @ C WATER HEATER S0. FT. RESID @11 t/. c SEWAGE DISPOSAL SQ. FT. GAR @ 1%c HOUSE SEWER Const. Lender Branch Supplimental Permit GAS PIPING PERMIT FEE 'Regisir. Fee $ PERMIT FEE PERMIT FEE Witness Fee $ TOTAL FEES MOB. HM. FEE MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE ELECT. FEE SMI FEE FEE PLUMB. FEE ��.• f :50''.%O 6. PERMIT NO. Job Address SpaceZip Owner ' 1.37477� '�+ A 1"1' - Community i! ) ' rV.l..,,.n• j Date - Dist. Off. F.C.C. MH.Permit Fee $ Micro Film Fee Cop' $ Use o Permitr' Am/�I, ) • 0/vc �• «��''^^ �} C- ?t1-3-6. .� Parcel No. jjsetCose No. JCZ Lot Size Mech. Fee Dbl $ PI. Ck. Fee $ 1/ -/ - 1 . F ' S cks S R Construction Fee Dbl E Legal Description � ^7�/ J,.�y - Electrical Fee Dbl $ +� Zone Restrictions Group P YP SMI Fee $ TPlumbing Fee Dbl $ Bond Amt. Pion N`o•. Plan ecker FinalDate Inspector Unit -Sp. Insp. Fee $ $ 'Demol. Fee $ Const. Lender Branch Supplimental Permit Numbers / 'Regisir. Fee $ Mileage Fee $ Address ' -City Zip Witness Fee $ Reinsp. Fee $ 1 Owne�Age, Tel. Zip Total Fees$ Add4e, City Zip M.O. W Cpsh Check Received by �•.. A - Contractor' Tel. License# required t�•' ppTrees bewpge System Address city��- , r, ,-ter ,e Zip .- �p T LL P Sewer District Form 284-208 (Rev.8/78) @s THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION ONORK verified by: FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. yi( NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs 8 Frms 34 Plenums 8 Ducts 2A Slob Grade 35 Furnace Comport. 3 Steel 36 Inlets 8 Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. 43 Final 10A Fireplace T.O. NO ADDITIONAL INFORMATION SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb= 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L.Line REAR OF PROPERTY LINE ELECTRICAL APPROVALS PSL P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME Building Address" Razdma Owner 4. 1 Mailing Address City wuttur Zip 906 Contractor Address Zip 4 4 Ubt CV T414f P.O. BOX 1504 No. 0862.1 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 1111a 1 0• Wilkinson BUILDING: TYPE -CONST' `.� OCC: GRP. �C 11716 Beverly B1W A.P. Number i Tel. 2iA/6142--9-212 & Classif. 413223 I Lic. # Arch., Engr., I Designer R.G. JElma Address Tel. City Zip I State Lic. # _ I .,._a _. rMme� t 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. J y _SIGNATURE R• f 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 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). ❑ 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.) O 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 contractor(s) licensed pursuant to the Contractor's License Law.) ❑ l am exempt under Sec. B. S 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 O 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 al Description t ect Description_�rai Sq. Ft. Size New ❑ No. Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ mated Valuation ;PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. AMOUNT Grading Driveway Enc. 0..04 Infrastructure MS. 12 25.00 TOTAL 3077.41 REMARKS rYl v c {jEf;va�tt-i1w, 7I,.-41E� 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 IST FL. SO. FT. ® $ UNITS SLAB GRADEO ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS PTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE Q DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN. SO FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING a f�1 FLOOR DRAIN MECHANICAL FEES 7 L2_0 WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE 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 MESH SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ®1+/� c SEWAGE DISPOSAL SO.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 GROUNDP UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADEO ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS PTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE Q GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM n FINAL INSP. _ GRADING cu. yd. $ plus x$ _$ LUMBER GR. FRAMING a f�1 FINAL INSP. ROOFING !/ VENTILATION 7 L2_0 REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND f% FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL P.O. BOX 1504 BuildingI 7&105 CALLE• ESTADO LA QUINTA, CALIFORNIA 92253 Address r' ri.,Kk... 1,.1:•x;:, Owner t I I f 11 r_ .. 1 1 11. -- Address City Zip Tel. Address Zip Q :n Tel: -> ti dam_ State Lia city & Classif. A I '-;k "-) ­) I Lic. # .Arch., Engr., Designer Gr, T,� e S Address _ � Tel. _ CityState Lr©L)Irl�l �aS� Lia# LICE SED CONTRACTOR'S DECLARATION I hereby affirm thio Wised under provisions. of. Ch r 9 (commencing with Section` effect.. ns Division 3 : ness and. Professions e d my license is in full force and effect. SIGNATURE DATE OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Busirress and Professions Code: Any city or county which requires a permit to construct, after, improve, demofth, or repair .any structure, prior to its Issuance also requires the applicant for such permit Ir to e a signed statement that he Is licensed .pursuant to the provkbns of the Contractors 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 •tire penafty of not more than rive hundred dollars ($500). ❑ 1, 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; Suisness and Professions Code: The Contractors 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. 8, however, the building or improvement Is sold within one year of completion, Ne owner -builder will have the burden of proving that he did not build or hprove for the purpose of sale.) - ❑ 1, att owner of the property, am exclusively contracting with licensed contractors to con- atruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law doesnot 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_ R, & 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 O Copy is filed with the city. O Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not becorrPlefad is for,one hundred dollars ($100)- valuation or less.) ' I certify that in the peA th0 work.for which this p tilt is issued, 1 shall not employ any,r in any as to become subj o Workers' G1Smpensation Laws of California Date Owner NOTICE TO APPLICANT: If, IM this Certificate of Exemption you shouts become subject to the Workers' Carrpensadon 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.) Lenders 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 andlstate 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 FINANCE, i,. APPLICATION ONLY ILDING: TYPE CONST. OCC. GRP Number Legal Description Project Description Sq. Ft. �No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated :Valuation PERMIT AMOUNT Plan ;Chk.. Dep. m l ,Plan Chk.'Bal. Const. Mech. r Electrical Plumbing S.M.I. Grading Driveway Enc. rastructure s - TOTAL 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 DATE INSPECTOR Issued, by: Date Permit Validated by: Validation: ' .. i. • t 4-:� { r`> 4P des.„�.v X1-•7 � y.�. .. a. SANDS`UNIFIED SCHOOL'DISTRICT DESERT `82 879 Highway 11f - NOTICE: Indio, CA ;92201 Documecnt Cannot Be Dupiicated 34M63I 4 Date 1671r�/90.' ` ” e.. . of permit La uinta y 101?6 No. .. �. Permit # . Owner Name William 1 O r Wilkinson' '� Log # No. `Street's S&`Below x , "! city,, La Quints, ,, lap 92253 study Area 0 APN 1i fact #►s �� WLot #i Square Footage 12,448 1. Type of Development Single: Family Re idence s No: of units 0 Comments 51 f�45 Ram7rP7 54 120 Ruhin52=2RR iVI niln�a .52-94(1 Navarrn51=R0 ' 1�Tavarro 51-745RerrriudaS 52'R9fHPrrPr``and .51-R79:.TiiarPw Tach h5me �G 1556 sl ff �(Ar`PaS - 1x�n'T16� 1 iii 11.1:, 2:in 71 2,A.in 1181 At the present time, the Desert: Sand Z4.ified SchoolDistrict does not collect fees on ga .rages/carports,"covered patios/walkways; `residential additions under 500 square feet, detached accessory'structures or replacement mobilehomes. jt has been determined the above-named 'owner•`s exempt from paying school fees at this time due `to the following reason: EXEMPTION NOT APPLICABLE K V r M& certifies,that scho11'.ol facxlityrfees'impoged puiFUa t to 36 ernment- Code 53080 the amount of 1:b8 �, X. 12 448 or$ X19 667. ti 84 have been paid to D:S.U,3.D. for the-property �i••r ..' ` . for Y this square footage in this:pro ..posed pro�ect:maysow iee issued.' V, y Fees Paid By = Wilham� O.. Wilkinson �, 'r Telephone 345.6W Name onahe ckeck g� Richard. M Beck `4 ,: `: •''' Director, Facilities Planning&Development Fee.collected /esempted'by- Shelley;D.=Bennett T Payment �F.e olved Signature -Creek No. 019694 Collector: Attach a.copy of County or:City.plan check application' form to Dich ict copy. Embossed Original- Building Dept:/Applicant Copy - Applicant/Receipt -Copy Accounting - _ .a ,.r ... <s.,3s. .Y :...•e, S, -sTas. +~_ w4��:'.'� '". ;R.. �4i9.i�4,.'... >.�^._... ..a. ., .c. _ ,, '::,RECORDING REQUESTED By I I T P .1 LE CU AND WHEN RECORDED MAIL TO: r Name William & Barbara Wilkinson etal street . 11716 Beverly Blvd. Address City& Whittier, CA. 90601 state L F MAIL TAX STATEMENTS TO: Name S'- Adde I -,a SAME AS ABOVE City & state Ic _j .jGrant ..Pee rd_1 L SPACE ABOVE THIS LINE FOR RECORDER'S USE A.P.N. 773-165-017 The.undersigned grantor(s) declare(s): Documentary transfer taxfs$ 9.35. X )computed on full value of property conveyed, or ) computed on full .value less value of heiis and encumbp'Einces remaining;� at time of sale. ) Unincorporated area: ( Xcity of 4U/ /wrla FOR A VALUABLE; CONSIDERATION receipt of which is hereby qc"owlidged, and LUCILLE WALDER, A WIDOW hereby GRANT(S) to,, WILLIAM O. WILKINSONAND BARBARA L. WILKINSON,.HUSBAND-AND'WIFE AS JOINT TENANTS, as to an undivided'';j interest .and JOHN L. HART , -AN -AN UNMARRIED MAN, a . s to an undivided interest, all ag:-TENANTS IN domm6k�,'-. the following described real property in thEi.. 'City of La Qiiinta County of Riverside State of California: Lot 5, Block 58 df--.SANTA.CARMELITA.,-,Unit No. 5, as per map recorded in Book 18 Paqp 63 of Maps in the Office of the Recorder e . c:'C6unty order of Riverside County, California. Dated: December 8., .1988 LUCI.LLE"WALDER. STATE OF CALIFORNIA SS. COUNT OF On no, cail C1�1f e before me, h.L a r-40tary Public in an for said State, personally appeared �me '(or (kn*own'to" proved to me on the.x,.ba.sis of satisfactory evidence) to be the person --whose name i S subscribed. to the within instrument and acknowledged that executed the same. WITNESS my hanqnd official se al Signature Name (Typed or Printed) at:Z_ OFFICIAL SEAL 0!7-1 MAI PELKONEN 'OTARY,'PUBLIC - CA.LIFURNIA PRINCIPAL OFFICE IN 'LOS ANGELES COUNTY amissI6 Expires July 19, 1991 (This ares'.for official notarial seal) Title Order No. 20043 Escrow or Loan No. 10-7764 UL -4 MAIL TAX STATEMENTS AS DIRECTED ABOVE.' 4, COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH r ENVIRONMENTAL SERVICES DIVISION 4 P?MIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Appllcant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn, to County speculations as Indicated on the attached check IIsL „ eA 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 for a period not to exceed one year from date of approval. n VERIFY ITEMS IN SECTION A FROM BUILDING & SAF&Y APPLICATION BUILDING DEPARTMENT APPLICATION LOG # � Agent Contractor, Person Phone Address &Firm '1Wells c'e.Y' Development T C b 5 PO e r k ' Phone Q1.3 Mailing Address 1 o 1 ev cl r State Zip 0 0 Job Property Address �. Legal Description (PM, Tract, '�.'S- iter A eZ-: 1 5- u Lot Size pr�Agenc r Use of Permit P/P, CU, etc ,a Q . Other fto wx �tl� Dwelling Iri Site Prep, etc. j Signature of Applicant } / Date CATEGORY: REV CODE FEEd - CATEGORY: REV CODE FEE Ltl' SUBSURFACE DISPOSAL 1238 7�0 • ,► �� 0 ❑ SITE EVAL ON UPON REOUEST� 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area _ 7346 $111�U0 O ALTERh1AT1VE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation L.ot Less than -�f� AiJ 87.00 SYSTEM 10 OOOSq. Ft.z� x1r 1,7347. . 7$ NIT AL DATE Holding Tank Agreements Completed Yesd ❑ Certification of Existing S.D. System Required ❑ Yes Q� ' i WOCB Clearance required. (Attach Form ❑ Yes t7No DOH SAN 007, Santa Ana Region Only) Sills Percolation Report Required. - ❑ Yes Special Feasibility Boring Report Required. ❑ ,Yes 4 '� of Detailed Contour P Pllans Required (1 to 5 It interval) , ❑ Yes' irp NI ka� Other * . ❑ Yes' t Staff Specialist Lot Inspection, Required ❑ Yes ,o Lot Insp cDane ^Soils boring report by Date Soils Map Page f� Soli Type P/^ Approved by Data r No. of Systeme Type of Systems) ,' ❑ ng Tank �-❑PFx ng "4."1 No. DwellingUnfts ( Bedrooms t"Px Melts (1) Septic Tank Soil Rate Grease/Sand G J New ❑ RepfacerrwrN :. �f�lLh M4k . l Gal cel Leech Line Sq. Ft a(Sidewall allowance I s) It. long n wide with Bed 6% it trench area K rock/ sq• It per running it min. _rock below dralnlines or of area Leachlines/bed special design'for slope:/ < Applicable 1- 4,6)'k Diameter � No. Pits Pit Below Inlet (&) (TD) Seepa ! R� 9eptfi pt N/A Overburden factor 6,(� ( Max. Allowable 7"� yo No. 2 System A,144 REMARKS- r 4 , I _4� ,d k - This application i PPROVED °P 1 D for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanie p of pfen, 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.,, --LL 1 Septic tank and sewer lines must be 50' minimum from any wells a /� f,( wa p/ W V&_ /^} •62.t� �� Leach lines must be 100' minimum from any wells, including expansion rea 1. "��� 3bLeach Seepage pits must be 150' minimum from any wells, including expansion area(y /0 I iJ (y 602 `r... �`F�`�GL�� /.2 Si nature of Health Official yke�'• rV J Date t' 2 -3 — Qn F RECEIPT NO. �� Issued By• f ' r Date ��/ ! 6 / DISTRICT: ❑ Riverside, O' IRdioo,:'0 Hemet D Perris ❑ Rancho Calif. ❑ Blythe 1 DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records, "r_. '