003039 (SFD)Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community.Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify._that X:�
developer of
located at
this District, has paid school Acility
authority4enerated by Government Code S
which is
within
fees imposed pursuant to the
ection 530_80 ip_the anjount of
covering a total of — :f,:5 12 — square
( ) industrial/commercial development and
this footage in this development may now be
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gia-19'ez= r- /,f CrV q!r�04�
feet o! Rk,-'T-residential or
that building permits for
issued by your jurisdiction.
for DESERT SANDS-UNIIFIED SCHOOL DISTRICT
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COUNTY OF RIVERSIDE, ENVIRONMENTAL 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 specifications required on the attached check list.
A non-refundable filing fee of $37 is required when the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log #
r•laere (O.vrim. Agent, Contractor, Etc.)
Melling Address
r
Ci=/y
State
Zip Code
Telephone
Job Property Address
'City or Community.
Legal Description of Property (Lot, PM, TR)
f
'Assessor's Parcel No.
Water Agency oc WBJL,,
�f `
Lot Size
F
L..►==
Use of pgrmi Planning Case #
i�
SFD, MH Site Preparation Fic
Signature of Applicant Date
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System required ❑ Yes ❑ No
WQCB Clearance required. ❑ Yes El No
Soils feasibility report required. ❑ Yes ❑ No
Detailed boring report required. ❑ Yes ❑'No I
Detailed contour plot plans required. ❑ Yes ❑ -No _
Staff Specialist approval required. ❑ Yes ❑ No Lot Inspection Date
Soils/boring report by Project # Date
Soils Map Page : "- Soil Type Approved by Date
Type of System:
No. of Bedrooms (1) Septic Tank Soil Rate Required
❑ Existing D-New ❑ Additional ❑ Replacement
:L.. Gals. tt
(2) Leach line sq. ft.
Sidewall allowance
Install Line(s) Ft. Long,
Leach bed Sq,
(Bottom_,trench area)
ft. rock/—Sq. Ft
_
-Ft. wide- ith min. inches
Ft. of bottom
` -
per running ft. 0 N/A
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No Pits
Pit 41
Seepage Pit total depth
Applicable
191 a-6'
%
/ .'
Max allowable depth
N/A Overburden factor
f'
This application is.apprbved/dePpa.,for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Sectio6'B' ab0V6.-A building permit is necessary for the installation of the above -designed system.
;(1) Septic tank and sewer lines must be`5b' from any wells f
(2) Leach lines must be 100' min. from any wells including exparlsion'area r
(3) 'Seepage pits must be 150' min. from any wells including expansion area
Signature of Health Official - Date
RECEIPT NO,
Issued by —
Date- _
District: ❑ Riverside ❑-•Indio
Distribution: WHITE —Office file
DOH-SAN-122 (Rev. 6/86)
❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
YELLOW —Applicant PINK —Bldg. Dept. GOLDENROD —Pending File
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
(760) 360-7448
(760) 321- 7448 CUSTOMER'S ORDER NO LATE O ERED
:j•E O
ORDER TAKEN BY 'DATE PROMISED ❑ A.M.
BILL Til ❑ P.M.
PHONE
J' i
CITY
HELPER
JOB NAME: AND LOCATION
❑ DAY WORK
❑ESCRIPTI6N OF WORK - - , ` ❑ CONTRACT
ElEXTRA
Q=�F'�°IT DESCI;IF71i]II pF AgATERIAL VSEp PRICE AMOUPIT
Gallons
Pumping Fee per 1000 gal. C�J
I. Dumping Fee`Ree',1000 gal. —�• o t
Out of Area Fee
Locating / Opening Fee (per hour.)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
1.8% PER YEAR WILL BE CHARGED ON
PAST DUE ACCOUNTS OVER 80 DAYS.
Houes LABOR AMOUNT TOTAL
MECHANICS @ MATERIALS
HELPERS @ TOTAL
LABOR
I I hereby acknowledge the satisfactory
Completion of the above described WnFk: TOTAL LABOR TAX
SIGNATLPRE LATE COMPLETELY
`>Z f �'QAI TOTAL `f