403499 (SPIN)BUILDING PERMIT
PERMIT NO. s DEPARTMENT .OF BUILDING A SAFETY
FIELD OFFICE osr .
4034 9 9 COUNTY .OF 'RIVERSIDE , y
J J a ,i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
2ND. Fl.
FOR. '
GAR.
CAR P.
WALL
•-
ESTIMATED CONSTRUCTION
SO. FT. @ t $ .-
- UNITS `
Zip
sYARD
SO. FT. @
SPKLR SYSTEM ,
'
SO. FT. @ MOBILEHOME SVC.
" BAR SINK
POWER OUTLET
SO. FT.
ROOF DRAINS
•@
SO. FT. @ -
DRAINAGE PIPING
SO. FT. @ '
-DRINKING FOUNTAIN
SO. FT. @ n•
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation'
SWIM POOL, PVT +
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
'VENT SYSTEM FAN + EVAP. COOL ' HOOD
SIGN - -'
WASHER (AUTO)(DISH)
APPLIANCE" r. DRYER +
Legal Dbscription.
f ! j..n,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED.
•F7 �'
y LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER -
.KITCHEN SINK "
ABSORPTION SYSTEM B.T.U:
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING,SYSTEM FORCED GRAVITY
AMPERES SERV ENT +
- SHOWER
BOILER B.T.U.
SO. FT.- @ a -
BATHTUB
•
SO. FT. @ a
.WATER HEATER
" -
50. FT. RESID @I %a
�' SEWAGE DISPOSAL
Unit
50. FT. GAR '.@ t/<a
HOUSE SEWER
Darrel. Fee S
-
GAS PIPING
PERMIT FEE
PERMIT FEE
,PERMIT FE "
DBL. -
TOTAL Fr��r\.S
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
�f) PLUMB. FEE
- -
PERMIT NO,.
403 4 9 9
- -
lob Address —.-
t-
-
', •a
- ,. Spoce
�,�•
'A"l,
Zip
Owner
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f. :, .. N t_
Community
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'`=
\
Valuation
S
Dote r/•
t -- A"'�
Dish
'! ` )ATI
Off.
F.C.C.
MH Permit Fee $ .
Micro Film Fee Cop S
e of Permit ;j�'�1.lr�(X�,.�•
C i`
_
Parcel No.
Use/Case No.
CLs,�By
Mech. Fee Dbl $L`Nl�!J1C
PI: Ck, fee S
Set Backs
Lot Size -
Construction Fee Dbl S
Legal Dbscription.
f ! j..n,
t�.
-
:#
•F7 �'
F `
S S
R I
Electrical Fee Obl S
ZoneReRestrictions
) . s.y .,
` •Inspect
Group
Type
SMI Fee - g
Plumbing Fee DbI S
Bond Amt.
$
Plon No.
Plan Checke
Final Date
Unit
'
Sp. Insp. Fee' - S
Darrel. Fee S
-
Const. Lender
Branch _'
Supplimentol
Permit.Numbers
-
r
s
Registr. Fee S
Mileage Fee S
Address City Zip
Witness Fee g
Reinsp., Fee S
Owner/Agent
_
Tel.
Zip
Tot I Fees ' S
�""�
Address
- l;r...•--.
y
•, J
City
_
• • _ _
Zip
' M.O. C. Cash Ch ck
Receivey
Trees req. ir
-
•
Contra r.,""^� ., (
( CW •
CA_L
T ..
Tel..
-
Ltcense#
Sewage System V<�
n`ddress �
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T LL P THIS PERMIT SHALL BECOMk VOID, IF WORK ISNOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
Sewer District 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
Form 284.208 -(Rev. 1/801 ' �► ORD .E WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. ;
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT .
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Own a Architect—_--_ —__ Contractor-_&kL{,iy_&&—D
Addre IRs Address___— Address
City 1\1m City — _ City---- —
Phone4. Phone _ Phone— ---_._
cc
W
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
Z
Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety
3
shall not make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W
O
without an encroachment permit.
NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be cuDie un 'I I (we) have
complied with all laws of the County of Riverside and the State of California governing said pro V
n
DATE��_r SIGNATURE OF OWNER AND/OR AGEN
Approval by Signature from the .Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
aaS I SPACE NO.
1 USE OF STRUCTURE
U to
JOB ADDRESS _
SINGLE. FAMILY � DUPLEX
Z W
n
L GA DESCRIPTI N OF P PERTY �� — 0
— APARTMENTS AGRIC.
,
Q
-'- r --- COMMERCIAL INDUSTRIAL n
j %A
COMMUNITY ALTERATIONS ❑
G
Z
NO. OF SUBMITTED PLANS — USE OF PERMIT
Lu
CASE NO.
z
NO. OF ARKING SPACES REQUIRED _— — NO. OF BUILDINGS NOW EXISTING -
ql
?
ZONE ` SETBA(fKS: FRONT 4 SIDE z REAR
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE L i
SETBACK ORDIN NCE -- OF FEET REQUIRED.ON STREET
DATE _ 4 SIGNATURE OF LAND USE OFFICIAL _ --
DEDICATION REQUIRED: YES ❑ NO P. NO. OF FEET -- —
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
H
d
W
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
ad
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
I
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
FLOOD CONTROL—
ll-
z AIR POLLUTION
_ DIV OF HWY
0 a — YOUR PROPERTY MAY BE SUBJECT TO
a
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
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
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Cleo once
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
43
Final
r�r
10A
Fireplace T.O.
°o
ADDITIONAL INFORMATION
------
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
R
Value
7A Wolfs (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
15
Ground Plumb
,
SEWAGE SYSTEM SIZE & LOCATION
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
-1 `r J
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
1
P/
/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
I
STREET NAME
P.O. BOX 1504 APPLICATION ONLY
Bui ing 71;105 CALLE ESTADO
Ad cess -( �- Q-2 LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: -
TYPE CONST. OCC_ GRP.
- -
7 -CitAddress _r7,3�E AL - A.P. Number -a (7 -
city
y Zip Tel. -- • _ _ _ _ _ . __._ _ . _
_ (niLegal Description -
ContractorProject. Description. �.
r -
Address I
City Zip . Tel.: _ - --- - - ----- - --
city----- _
8, Classif. Lic. # - -`
Sq. Ft. 1�`0. 3 No. Dw. _
Arch., Engr., _
Size —. -�>- -d---'Stories
Designer -` -�; -' 'N -0 ❑ q --Add ❑-j""Alter 0 "Repair 0-1 --i emolition ❑
Address Tel. i
City Zip' ._. � Stater -
-_ Lic. # !..-
LICENSED CONTRACTOR'S DECLARATION
hereby affiMthat I am licensed `under provisioris of 9 (commencing with Sectlon
7000) of ion 3 of the Business and Profesalon { Code, and my II & nse is In full force and
effect: -
l
SIGNATURE DATE '
-- _-- _- OWNER-BUILDEWDECLARATION--- ` f
I hereby affirm that I am exempt from the Contractor's License Law for the following _ EstImat-ed"V-51u1tl-O'n'"'
reason: (Sec. 7031.5,13hrsltess and Professions Code: Any coy or county which requires e - -
permlt to construct. atter. Arprove, demorsh. or -repah • any structure, -prior to Bs-lssuarnce afso__ _ ---
regires Me appreand for such Penult ro-nae-a-s>Qned-srareme„rrnarfre-tr-r>�rnsee•purs�rd-ro —..PERMIT-- ---•----gMOUNT:-
Ore provisions or the Contractors License law, Chapter 9-(oonrnerecb�p TM Section 7000) 0, „ �� I
0hdsion 3 of the !dress and Professions Code. or that. he is exempt M"tiom, and Ore basis ” �' -- -• .{ -
lar Ore •aWged exerrjpOorn. Any -vteWon cr'SecOoir-7osr`s'oy r acPer�,rc'ra'a-vern+- --Paan Chk-Uep: - -p- - - ---
st jac/a Me appieant to a dN penaty of not more than, five huddled dollars ($500). -
❑ 1; as owner of the property, or -my employees with w as their sole co Plan Chk. Bal. " '' ^�"�" '- • t
ag compensation, -will— _
do the work, and the structure is rot Intended or offered for safe. (See. 7044, &dsness and (
Professions Code: The Contractors License Law does not apply to an owner of property whoV HCO0St. »u ; -o,. cr• a_ v.:• f
brads or hproves Orerean and who does such -worA•hknsaf/-or mroupl;-hls.ownterproyees,---—Mech-.--
Pro~ Out such !•rrprovemants am not Intended or offered Iw sale. 11, however, Ore bnim•g -
or hprrn
oveent is SWIWN* are •year of completion, the'"owher-0uder waf have Oe burdere! : Electrical
Juue') ctc. _"•;• j'"-"•_
of pmAV Mat he did not bub or lhprove for the purpose-ol sere:)—•-_.. ___may
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- q Plumbing stills 1
struct. the prQiwL.-lSec._704-4._&Mhgff erW_Protessions Code: The Contractor's License law "
does not apply to an owrhe of property who triads ororimproves fliereorr. end who contrad /o'r—S:Ml..
such prgeets with a contractor(s) licensed pursuant to the Contractor's License Lew.) , �. . _. - s
• ,_ :-s.
------.--- _____ _ _ . ___._ ; Gradings----
❑ 1 am exempt under Sea a. 8 P.C. for this reason - -- --- —
i Driveway Enc..
Date owner
WORKERS COMPENSATION DECLARATION (J-- - — -
Phereby affirm that •t have -a -certificate of -consent -to self -Insure, -or -a -certificate of--
Worfer's Compensation Insurance, or a certified copy thereof. (Sec. 3800, labor Code.)
Policy No -- - -nPynY •- - -
❑ Copy is filed with the city. ❑ Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
section need not -be completed If Ore pemitr isfox one'h hmdred dollars ($100) rafuatlon
1'certlly that In the performance of the work forwhich this permit Is Issued, I shall not
employ any ppeerson in arty manner so as to become subject to the Workers' Compensation
-Laws of Califrrrnia---- --- -- --
Date Owner
NOTICE TO APPLAGANr: ly, -after maAfng • this Certificate - of Exemption you should become
ayject to One Workws' Compensation provisions of the labor Code, you must forthwith
oonp/y wlth arrdn provisions or uttr psmdt shall w deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby effirtn that there Is a construction lendl%agency for the performance of the
work for which this permit is issued. (Sec. 3097, CNB Code.) 3
Lender's `Name - - --- - - - -
Lender's Address
This Is a building permit when pfbepedy 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 state that the above information Is correcL
1 agree to comply with all cl 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 Adc
city, State,
Inffastruc utut re - —`--- �- '-- - -
t
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback fromCenter Line_-
RearSetbaA from.Rear Prop:-L•ine - --- -
Side Street Setback from Center Line
Side Setback from Property Line -'
FINAL DATE
INSPECTOR -
Issued by-
Date ' Permit
Validated by:
Validation:---
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SC11OOL FACILITY FEES
NOTICE: THIS DOCUMENT CANNOT
BE PLIPLICATED,
TO: City of La Ou n a DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to ce ti-fy that Jkl.1dw /',- r
developer of A ZA /V) ae__ —A P 0-"I/ L4tkJ, ie h i c h i s
located at *K_T69-q ��)(M (aA-u L2 -_;J1 within
this District,'has -paid school facility fees imposed . o the
autbositv ggperat Co e Section 53PPO 'n &hUamou f
$,_4A It by GQvlernment
_x I r
covC-ring a total of square feet of AV &s iffential'or
( ) industrial/commercial development and that build ng permits for
this footage in this development may now be issued by your jurisdiction.
1341,S4
for DESERT SAND9-UNIFIED SCHOOL DISTRICT
White - Building Department 9 Yellow - Facilities Planning 0 Pink - Accounting 0 Gold - Developer
(10)-37
Vllr'11V V6. VVP1�7 111 l:G VV.
Order No. k=69823-1
Escrow No. 10-7436
Loan No.
WHEN RECORDED MAIL TO:
Dan M. Baxter and Kay F. Baxter
lit 52-545 Qvenida Vellejo
N La Quinta, Ca. 92253
ac s
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2� % 1 =��
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5 J W
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SPACE ABOVE 9; IS LINE FOR RECORDER'S USE
MAIL TAX STATEMENTS TO: 63 25
DOCUMENTARY TRANSFER TAX $ ........ .....:................................. '
SAME AS SHOWN ABOVE X... Computed on the consideration or value of property conveyed; OR
...... Computed on the consideration or value less liens or encumbrances
remaini at time of sale.
remain7
Signature of Declarant. or Agent determining tax — Flrm Name
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JOSEPH P. PALOZZI, Receiver
hereby GRANT(S) to
DAN M. BAXLEY AND KAY F. BAX`LEY, husband and wife, as joint.tenants
the real property in the City of mu/K-+� .
County of Riverside
,State of California, described as
Lot 16 of La Quinta Golf Estate No. 1 as shown by map on file in Book 37 pages 96, 97.
and 98 of maps, Records of Riverside County,.California.
Dated July 26 , 1988 6 . _ .
Josep P. ,Palozzi
STATE OF CALIFORNIA Iss.
COUNTY OF Riverside )
On August 9 7988
before me, the undersigned, a Notary Public in and for said State, per
sonallyappeared Joseph P. Palozzi
personally known to me (or proved to me on the basis of satisfactory E::y
FFICIAL SEAL
DA S. DE LEON
evidence) to be the person(s) whose name(s) is/are subscribed to the PUbllc-Callfornla
within Instrument and acknowledged to me that he/she/they executed ERSIDE COUNTYm., Exp.:Oct. 28, 188Q
the same. ,
WITNESS my hand and official seal.
�lJ'� �i� (This area for official notarial seal)
Signet a �ff� "
1002 (6/82)
MAIL TAX STATEMENTS AS DIRECTED ABOVE
�{ �e7Frr..ar t"
o
4 n 1
tit
typo. yea
UNE
J
AGI tI :ULlMAL COMMISSIONt'It_
AND
WI:161 11"S & HLASURE.S .
49-613 Ilwy IIG, Oulte 11-I2
-Cvnchelltr, CA 9Z2JG
61Y J��Z-0191
bEVCLIOt?Cll' 5 Id)V w L
E. LEM SI'M;GY
�o•a.n �;ur. •tn
)ANIES 0 WALIACE
A�S�StA�I �!1'•t••115Sn7�f.R
CLENIEN1 Bt.`vEhlSIE
suttn
'I r,E,�11 tutaC t
tell)
War Vevelopert
t 111
Alter reviewi iq your lalltlsctlphitl Itltl113, tell I)lattt material listed
dsIS titutiot►s
violation o[ quaraltti6e ltaws tloveltllny tip-,Coachelia Valley.
LE rial listed,, tills oC[lce
do occur Olid they diE[er [tun `Irlaltt n►IleMust be ttoLlEled
iatnlediately .
tl'1"xk you Lor hrotectLly alld I'Lesetv1119 the Coachella Valley's pesL-free emiromellt-.
v
J1gr�cuJ tuu�al Camilsstierl . 6MCO
cct 11010 mid 111VOtside U[ [ 1ce
s. Ytq � y j r rr�, r•� t F'�1 z�! ytµ"�. 4y. 5 7 ir'Lc*^y�+ 'c:7 .^^ i� '� . y ++r + z*�z.�
�`� �rr`� : i� �"`� t'�^ � Phi+" S�"ty r• 3 p,' `- Q �''F•3�` � '�+%,��p;'� �. �t •'�xieiy M1��-uiY'ii t�9 , -eF -y� .:.�..••%.,�."^ �..4.1�'' 'r��,"s�SA
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH A°m°O'° Paroel No.
I
ENVIRONMENTAL -HEALTH SERVICES — —
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 for a period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'
Agent,Contracto, Contact Person
Phone
Address & Phone
_
4) k
4�- 4
% E` UfA .1A
IOwner
Phone
54----70M
Mailing Address
- a ' 1AX QA
City _
State
0.a
Zip
Job Property Address.
Legal Description Prop. (PM, T Lot)
oR--
Lot Size
-te► . 'nc II0i,
'Use of Permit P/P. CU, etce,r,�„
Other
�D
QS K % O
�.
tell-SI9 MH Sire Pref, etE % (i E t 1/,
- it;rA
L
4 10
Signature of Ap icertt I
date
CATEGORY: REV CODE EN\CATEGORY:
REV CODE FEE
O`SUBSURFACE DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME -
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. .7347 $86.00
I�NITI!ALl DATE q
Holding Tank Agreements Completed ❑ Yes
Certification of Existing S.D. System Required ❑ Yes
WOCB Clearance required. (Attach Form ❑ Yes PYNo
DOH SAN 007, Santa Ana Region Only)
Soils Percolatfon Report Required.. ❑ Yes _ ❑ No
Special Feasibility Boring Report Required. ❑ Yes
y
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes o� _ _,
- ,,-..<. -- •
❑ Yes No r
Staff Specialist Lot Inspection Required ❑ Yes No
I Lot Inspection Date
Solis boring report by P�rjoject # Date
/
Solis Map Page ( 1 Sca TYPO �n Approved by b., /y
-- Dom
No. of Systems
Type 61 Systems)
❑ )folding Tank ❑ Existing
Na Dwelling Units ( 1)
Bedrooms, FbduretlnitsG—%we,,lntcp
(1) Septi: Tank
Soil Rate
�Grease/Send
H'rlew ❑, Replacement
3 G /l.M Z r� llAA j '
,
Cael
(2) Leach Line Sq. Ft
Sidewall allowance
Install uns(s) it long r+ wide with
T
Leach Bed sq. ft
R rock/ s4. R
per running ft ❑�.
NA
min. ln—ctw"`"f k tbelow drainlines or
"�
lafbotk
{
-
Leachiines/bed special design for slope:
(3) Pit Diameter
No. Pita
Pit Below
Seepage Pit Mal Depth
`Other.
Applicable
Q^p8 LY" 6
(
inle"BI)
r
0
Max. Allowable Depth
N/A Overburden factor •
1-
(0
O /
No. 2 System %V l -a
REMARKS: `-'�L
n f 4.�-�'• lfly. ,C�..-c, v�✓�Q .�rjl.... -.-''�L^-`£+`7?1�- i' .l �°�j/ lX�. Qui.
�,./
C •
This applicationIs�APP O ED NIEWfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot-'pian,.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 10096 expansion area. _
1) Septic tank and sewer lines must be 50' minimum from any wells q/0
_ Leach lines must be 100' minimum from any wells, including expansion res G f _
(3) Seepage pits must be 150' minimum from. any wells, including expansion area
G
� 214
Signature of Health Official �7 �'t%'' C
RECEIPT NO., Issued By -
DISTRICT: ❑ Riverside, ®''Indio ❑ Hemet Q' Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
5