00011956 (AR)AYYLIUANT NAME (L. F, MI)
M
A DRESS
6 ONE VELASCO
4. WCONTi31E/ZIP CA V27.336000
� F�DRESS/SPACE AWE VIELASar0
EWCO �"'21530060TAW/ZIP
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03
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*44.52
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CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
TFEEL
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE N ,
LICNC N
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ZONE ORD N
LOT SZ1i7
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CONS11RUCTION I"il�
�►� .Ilk0
PLU" S INGF F9Z
*21.50
WL9CT*lCAL» F&E
$20.00
"Isc i LAl7CHKCK FEE
*44.52
$"I FEE
1
SYRUCTUtRAL t BUILDING PERMIT
TFEEL
yd sI i+
INSPECTOR'S COPY
01
S T R U C." I U R A L (. SUILDING 9• P 9 R M I T
TOTAL PERMIT COST IS $155.05
CON67RUC` ION IS11"ATE (NOTEt NoT To be usad as properTy vol,+sotion)
77 Dv*+�c,riptlon FCC group T par 64 F1 8410 Vaal.ua�'tion
Flt ��al.pAilt 800 $9.10 $721614
1
all WD As $4$2315
C'* rw Dior+ ��► �Iward an ate a�a;tua �► w x;ipn of *76T,5 ist $419.50
iN' cT*lc^4 FEE COMPUTATIONS * Permit Fte* of at R'iitwa►ble) Fes: 43.80
res . a ps-•A : X0(7 Marvice Ari -•2 t Q 4aury asps- 34 V F t $7.00
a Soo . Ft Id1 r Ft. InRE
t $14.06
P1`.:' frEf COMPUTATIONS * Permit F00 (if aspplic�tb'rt,} feet $4.00
F1XTU rtv—ftr $Ink I 0 tii:nki.ra brit":0 Fle Draain t 'Q
4(iticl� .4ink 10 (.aaundrt Troy i U : rinal a 0 Wtr CXafsot t 0
P4,0 t+as .,1. wage *p*sa —Ni-t�Y Oid t N FrAt t $10.00
R P%s t,i 1t T t � Aratoa *, Vt neo Wator W�p�rl:c�%' r tvaetntl ! : �►2. @
' nl l ilabtioo of Wator Piping aandiii Wast*r i'roo mont Equip:1 FU $2.56
we P$..AWC'l cx Fee $44,52
A
FORM 284.208 (2/81)
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
!.
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
-
33
Ventilation System C
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 Deck39
Apal. Clearance
7
Framing
2 • 'z6 -
40
Fire Damper
8
Vents
f,r
1/
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
43
Final
10A
Fireplace T.O.
Ej
°o ADDITIONAL INFORMATION
_ _ -- ., -- - _-----
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade �L
INSULATION Thick R
Value
7A Walls (Batts)3-
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final _ Z
--------- - -PLUMBINGAPPROVALS--- ------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb . 16 r SZ, eeeac~
18 Vents
W Sewage Disposal
MIt C-
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
_
Tank O Pit L. Line
REAR OF PROP TY LINE
ELECTRICAL APPROVALS
P
f
P/L _!/11t, \ I P/
N'
.
26 Power Pole
27 Conduit
28 Service Entrance17
29 Wiring 2 2-
29A
29A Grounding Wire y/ C/
29B Bonding
30 Fixtures f— i'" 8L
31 Service
32 Final
STREET NAMEy "e`er L,A" '
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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 plari 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
Ate.
'Legal Description.of Pro erty �rR.+c
'Assessors Parcel No.
77-5
Water Serving Property From V f
Signature"oypplicant 101" Dale •
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
I.nitial Date
\Soils* feasibility report required Yes ❑ No ❑'�
=:. 10,r , r
Detailed boring report required Yes ❑ No 0
Detailed contour plot required Yes ❑' No
ti•
` `"
Soils or boring report.by %�Date ���
41
A/Approved by !L �'ZJ-G �.t�.-�-. / Date
�T
a < i� ' ' L at! C GLta. a y
P Page, a`�aawl-�
Soils Ma Pae Soil Type .iTract• File No. Other -
Number of Bedrooms
ar � D%�dOM ACIWAC
SepticiTank Size (gallons)
Rate Required (sq. ft./100 gal or gal. sq. ft./day)
k
3 9F_P400Vk
Leach line sq. ft. of bottom area trench "
Leach bed (sq ft f60'bottom area bed) ,
Seepage Pit Diameter
Seepage
j/Vertical Feet
Number of Seepage Pits
Maximum Depth of Pit
j�Pit
T•
Location of System
Additional Requirements h•'
A permit is approved/denied for the installation sof a subsurface disposal system as indicated on the accompanied
plot plan using the requirem////effnts sd.t�t forth in Sectttiiion <G above. • •,
/_'�
Signature of Health Official • L ' r Date % • - '
Receipt No. Issued By
District:
--�-�'--
District: Riverside ❑ Indio 0� Hemet ❑ Date
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Attached to Plans
DOH SAN 122 (New 10/81)
APPLICANT NAM, JL. F M
Mb AVE-VELASCO
MCOMMyrzIP CA 1112!$30000
01 V[ DRESS/SPACE A� j�t VEL-4000
EL- .00 j�rl�a�ty
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9yj��0��j}}'a
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j"%q ML, F, MI)
RONALD WlA D W
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
a`
r'
PHONE N
LICNC #
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PH ONE 0
LLIICNyC�#
F�j�7t��y �} �y gyp
P i1 : mm.iAi T.�gt[,d�/� �g�l+�.siT;.i��.i .iec +LY 1' u 7 U
(bgg��is0
61.0
ypyli
$ff
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qS
FFY' y�
ZONE ORD #
LOT SZ
ffp�
fd'o
0
P0011"9�6 Aa v� °"��e. 018340
TOTAL
FEE
NSPECTOR'S COPY
APPLIOATION VOR VOW: TURAL PeRhj"t
018340
;Voll oust 1160 the. following, Doparrt.Mao s of 110.10?d) for' Cbncul-rend !Ar7 YRr:
.w ayj.Tn wa!w �FrnMM�j t'H`eMlw'wrwA..:ufq's..nH+q]f.a.ww!1b!h11:n w��+Mww .ry. }!n iingr+:�.til:aw.w�+a►. ti.-.:w,!�k �ytawc.wicipi 0.Rac M(r-�+F.vi
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & 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
Ap3l. 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.O.
°o
ADDITIONAL INFORMATION
-
t
- •---------,___-- ------
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internol Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 Ceiling (Batt.)
12C Ceiling (Blown)
14 Final
----..__..�—_----'-FLilrlri6ir�"� iaPFROJAi� --�--- -- ------ ---------------__�...-----_---
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Servi;e
24 Gas Test
25
Final
Tank Pit L. Line
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding 'hire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME