018042 (PLBG)(L, F, MI)
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.'JOB SITE ADDRESS/SPACE
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CITY/COMMUNITY/STATE/ZIP
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PAG
PRC
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M'TRACT LOT
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T(iACT NAME
t' Y&X_1 as
OWNER NAME (L, F, MI)
Er
TRACTOR -FIRM NAME
-ADDRESS
C I TY' COMMUN ITY/STATE/ZI P
1192911
AAM
PHONE M LICNC N
�.i '31
ARC/ENG FIRM NAME
ADDRESS
r CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE OF PERMIT
BL
ZON
FSB
SS8
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
IMPtILK
TOTAL
FEE
018042
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14 LLiO ll i *Ii. _
G I�
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slab 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
G,oge Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
Fireplace T. 0.
❑
°o
ADDITIONAL INFORMATION
---------------------..___
S%E�W�gGE SYSTf M S IZE 8 LOCATION
11 Exterior Lath
12 Inte—I 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 / S
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank / J CJ Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
o 0,
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
r s
WHEN USING A: TYPEWRITER, SET TAB STOPS AS SHOWN ON THIS STUB.
,01 0 0 0 0 0 01'0 10 0 0
FORM 95-2 Available fromAeBs° Inc. Groton, Mass. 01450 = Use with #772 DU-D-VUE Envelope — SAVES ADDRESSING TIME
3 3 3 ���
BELL PUMPING/BELL SERVICES DATE
P. 0. Box 1255
PALM DESERT, CALIFORNIA 92260
RIYERSIUB"
DIVISION OF ENVIRONMENTAL KFJ TH
(714) 328-6718 or 346-6916 '7
:. Sewage Disposa e—
Food Establishment _r .: .; J SS Gal. Septic Tank M•y
Trailer Park el t„/; _—T Sq. Ft. of Leach Line
�"i�iX,�� Seepage Pit
Motel, Apt., Hotel
Dwelling Connection to Sewer
Ir Commercial Building +
Swimming Pool
water softening devices may be discharged into the individual sewage disposal
No on regenerating y
oved source., Codec
Quality Control Board.
system herewith approved without clearance from the Water Q Y
�^ Water sng
upply serving this installation must be from an appyof royal.
— Ail sewage disposal instal!ati nn n xc conform
sfof f urt t4)ef zit willnnullifycseBoa d for
Inst approval.
off the sew -
Any cutting, grading , or filling
TERMSp(OVd) has been obtained from the Regional Water .Quality Control
�,,.,♦ ,,( D,1l,I1r Health approves for 0eewi3e'+Ey, construction
age disposal system. PlE E C �9 M1ORWC W(I 1SE�iTMNCE
s
— -- -This 15. 3o eertify_that the PiVW 16L CLQ„
br irtstallatlo the..item(s� i hel ked above _—�
DATE"'_'.I ' r` Y^ :- �_: 'CHARGES AND CREDITS �
to
rj3nlG
BALANCE FORWARD
Q Z,
c�
I�z
(0x10 12 323 /9JICN�dA �3EeM�d�r
Interest at the rate of 11h% per month on overdue accounts. In the event
of suit to collect this amount or any portion thereof, 1 agree to pay
reasonable attorney's fees.
BELL PUMPING/BELL SERVICES
PAYNT
09"Iyew 4��"
IN THISHIS COLUMN MN
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RIVERSIDE COUNTY DEPARTMENT OF HEALTH
APPLICATION FOR PERMIT TO INSTALL A RESIDENTIAL SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to the specifications required on the attached
check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to
County of Riverside.
Name
Mailing Address
City
State
Zip Code
Phone
'Property Address
'City or Community
'Legal Description of Property
'Assessors Parcel No.
Water Serving Property From
Signature of Applicant Date
'The above information must be verified from Building Application
F-- Staff Use — Do Not Write Below This Line
Initial Date
Soils feasibility report required Yes ❑ No ❑
Detailed boring report required Yes ❑ No ❑
Detailed contour plot required Yes ❑ No ❑
Soils or boring report by Date
Approved by Date
Soils Map Page Soil Type Tract File No. Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required (sq. ft./100 gal or gal. sq. ft./day)
Leach line sq. ft. of bottom area trench
Leach bed (sq. ft. of bottom area bed)
Seepage Pit Diameter
Seepage Pit Vertical Feet
Number of Seepage Pits
Maximum Depth of Pit
Location of System
Additional Requirements
A permit is approved/denied for the installation of a subsurface disposal system as indicated on the accompanied
plot plan using the requirements set forth in Section C above.
Signature of Health Official Date
Receipt No
Issued By
District: Riverside ❑
DISTRIBUTION: WHITE - Office File
DOH SAN 122 (New 10/81)
Indio ❑ ' Hemet ❑
YELLOW - Applicant
Date
PINK - Building Dept. GOLDENROD - Attached to Plans