04251 (SFD)Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
On _.E�99L FACILITY FEES
TO: City of La Quai,nta DATE:
Department of Community Development
78-105 CA1,le Estado
La Quinta, CA 92253
O)A
This is to certify t7 -hat 'NW —, , . /I _01i�_
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developer of A h , which Ji-
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located at within
this District, has paid school faci,1&Tty fees imposed pursuant, to the
au�dtority g rat4j,1;iy'9Xvernme.nt C d S tizin �5408OVn�/�e am nt o
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N lzrt I Ig &A Z( YJ 4 j,P60KAA-11V/L fv= 1. _W
I A"ot - Ad4Z
covf�ring a total square feet of residen tP 1 or
( ) industria.1/commetcial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
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f6rb_E§ERT SANErS.UNIFI—ED SCHOOL DISTRICT
White -Building Department 0 Yellow Facilities Planning 0 Pink -Accounting 0 Gold -Developer
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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 $40 is required when the application is submitted. Check must be made payable to the County of Riverside
1
I ••; A Building Department Application Log #
Name (Owner. Agent. Contractor. Etc) +
Mailing Address
E
City f�
Stale f Zip Code
Telephone
'Job Property Address -: ,m &
'City of eo jtnity,
'Legal Description of Property (Lot PM TR)
*
'Assessors Parcel No
Waler Age-n'c .%,Well—
RI Lot Size
Use of Per-il P1anrr1fg Case fir
C■�L� J
S e <' 7� I
—
�1 V
SFD MH Site Preparation Etc
�( l jJ //I P
Sgnalure of Applicant V 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 ❑ No
Soils feasibility report required. ❑ Yes ❑ No
Special feasibility boring report required. ❑ Yes ❑ No
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 I lF r Soil Type �' il� Approved by GA Date r-t d
Type of System:
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
Existing � El Additional ❑Replacement
El Existing
3 i'Y- �
: •
Gals.
�.
y
(2) Leach line Sq- ft-
Sidewall allowance
Y
Install "!- Line(s)Ft- Long,
♦�
Leach bed Sq.
(Boto•• t ncharea)
ft. rock/ Sq. Ft.
Ft, de wit0,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 BI
Seepage Pit total depth
Applicable -:,,_
Qz ❑ 6'
r r�'
Max allowable depth
N/A Overburden factor
r ,
r
This application is•g ovr ed/derad far the design of a subsurface disposal system as indicated on the accompanied lot Ian using the requirements
PP , P.��. 9 P Y P P P 9 q
set forth in Section B above. A building permit is necessary for the installation of the above -designed system.
i t 1r :. !_ i': f {-a-�:%_ �i�•
(1) Septic tank and sewer lines must tie,50' from any wells _
(2)- Leach lines must be 100' min, from any wells including expansion area, *-Ca 6l
(3)� Seepage pits must be 150' min. from any wells including expansion area
Signature of Health Official Dale
RECEIPT NO._
Issued by
Date
District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE —Office file YELLOW —Applicant PINK —Bldg. Dept. GOLDENROD —Pending File
DOH SAN 122 (Rev 8/87)