05577 (SFD)Building 53-365 DIAZ
Owner
Coachella. Valley Lattd
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 247'e',TahquitZ I -lay #2
c"Palm Spring$ Zip 9226
Contractor I
Starr Construction
same
city
State Lic. City
& Classif. 387934 Lic. # 895
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of ivision 3 of the Business and Professions Code, and my license is in full to and
effect ri (�!/ ro
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.S. iciness and Professions Code: Any city or county which requires a
permit to construct, alter. krprove, demolish, or repair any structure, prior to its issuance also
requires the appicart for such Perim it to lie a signed statement that he is licensed pursuant to
the provisions of the Conbacto's License Law. Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenalty of rot more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Uuisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
bolds or improves thereon and who does such .work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvements sold within one year of completion, the owner -builder will have the burden
of proving that he did not brad or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con•
struct the projecL (Sec. 7044, Business and Professions Code: The Contractor's License Law
does no apply to an owner of property who bultds or inproveS thereon, and who contracts for
such prciects wth a contractWs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Ser B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereo/(Se
f c. 3800, Labor Code.)
Policy No Company e ' 4K
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be eonpteted it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of RV work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California-
Date-Owner
aliforniaDateOwner
NOTICE TO APPLICANT: /, after maAfg this Certificate of Exemption you should become
subject to the Rlarkers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or Itis perm shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Nam
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct.
I agree to comply with all city 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 Address
City, State, Zip
No. 45577
BUILDING: TYPE CONST. -OCC '
ONST.OCC. GRP.-
A.P. Number 774-071-018
Legal Description lot fi BU 183 Unit 18
Project Description SFU
Sq. Ft. 1409 No. 1 No. Dw.
Size Stories Units
New)] Add ❑ Alter ❑ Repair ❑ Demolition ❑
430 squaws 4oet Carage
170 feet 6 -foot Wood Fence
Estimated Valuation $76,360.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.013
Plan Chk. Bal.
•
Const.
536
Mech.
4 •J15
Electrical
10b .41
Plumbing
! • au
S.M.I.
•
Grading
tY . VV
Driveway Enc.
WU.UU
Infrastructure
t b
TOTAL
REMARKS
r
..l .;
Iyr,c. t t:'i.
t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 3j311$ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
eme SLAB GRADE l f
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (FINAL)
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN
GROUT
WATER HEATER
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
�� /
C(�p
GFrA'jt
5
CCCO00
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® Wic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
09 SETBACK - U
4 0-
OLIND PLUMBIN J
UNDERGROUND
A.C. UNIT
COLL. AREA
eme SLAB GRADE l f
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPT
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
L_
ROOFING
�� /
C(�p
GFrA'jt
5
CCCO00
r w . �.A--1REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 7— �p `
MESH
`INSULATION/SOUND7-5-61
FINISH GRADING
gifFINAL INSPECTION q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t
Building
Address
Owner
4 4 Qum&
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address o2 y 7 Lc 1,q 1.t. Q cJ r 7-7 tV A
City C Zip Tel.
F/,7 /-,w 5 2lrxs Z <r z
Contractor
City
State Lic. City
& Classif. 38 7 F3 Lic. #
Arch., Engr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underrpiovisions of Chapter 9 (commencing with Section
7000) of Divisi 3 of the Business%d/professions Code, and my license is in full force and
effect.
SIGNATURE —� DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License taw, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. ff, however, the building
or improvement is sold within one year of completion, Ore owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. R- & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent o selbinsur , or a certificate of
Worker's Compensation Insurance, or a certified copy th of c 3 0, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
of less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of c1 ornia.
Date Owner
NOTICE TO APPLICANT: If, atter makhg this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance of the
work for
which this permit is issued. (Sec. 3097, Civil Code.)
Lender's 'Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days -
1 certify that I have read this application and state that the above information is correct.
1 agree to comply with all city 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 Address
City, State, Zip
BUILDING*DIVISION
BUILDING: TYPE CONST.' OCC. GRP.
A.P. Number 7 741 iIg ;z / — O 1A
Legal Description GL,, ,r / 8
Project Description
Sq. Ft. No. No. Dw.
Size Iia 9 Stories Units
New 19- Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
77us 40
PERMIT
AMOUNT
Plan Chk. Dep.
(, a c�
Plan Chk. Bal.
-
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
t7�
Driveway Enc.
e
Infrastructure
f Gs�M )v
ss.v
TOTAL?
D
REMARKS
,, .,;� ?194_03--21-89
_ _ __10
1-9 ,�- jl 1 Y
I Ll I r1L J. i:. t _3i. VU
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. . SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT: ® - -
-
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
-
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DIS H)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
KITCHEN SINK
ABSORPTION SYSTEM. - B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Arq�g9
OIFICE OF
AGRICUL'I URAL COMMISSIONER
AND
WEIGHTS & MEASURES
49-613 Ilwy 86, Suite B-12
'Coachella, CA 92236
619-342-8291
E. LEON SPAUGY
CO�nnSaO�ER
JAMES O WALLACE
ASS;STANE (:')*4M1SSIU%tP.
CLEMENT BE`rVENISTE
SEALER
DATE il/Lq-wc �'-f l4�`� _. CASE M. L- E
DEVELOPER'S NAME t S % fL,Q 2 Cm 3 r2Ua ri o
ADDRESS t -2'y 7 ?Af/Qa / T'L v&;I ' Y
TEL,EPLIONE t (
Dear Developers
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ fran plaint material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free enviromient.
P_ A I L
A icultural Cannissioner's Of f ice
ccs Indio and Riverside Office
S3 Sys- r/fr/_GE"/o
'e. m r 3 -Q4- *�' z a
774,/1 /2.Z- o/j"
0
I
AO
f
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel Hoff% 7#L c7l _ d / y
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.
Q VERIFY ITEMS IN SECTION A FROM BUILDING 3 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
Z
O Agent, Contractor, Contact Person(r Phone Address 8 Phone
U 6 �GixJS4 do AJ 3 ZZ=JOzo
W Owner Phone * Mailing Address
V) I 2W `7 .f_t' 7A) ottzV el o I - r— uJ 4 -J '� Z
Soils boring report by i �/ Project # Date r
Soils Map Page ' A W Type �)�" Approved by "' e' JI'L Date
rr
U No. of Systems Type of System(.) No. Dwelling Units (/) (1) Septic Tank Soil Rate .,presse/Sand
Z ❑ Holding Tank ❑ Existing Bedmome, fbdw.r. lnitit ,,y !/' - / •Gftase Intcp
J :7'14ew ❑ ReplaoertreMD�/j
� T "���
� fff �''j Gal
U _ v v
to (2 trenchftttom t Sidewall allowance Install— L, Une(s) ft. 101V fr wide with -.Leach Bed sq. ft.
area ft rock/ sq. R min. .rches rocik dremlines or of per running ft.
�_
O!NA
Leachlines/bed special design for slope: (3) . Pit Diameter No. Pits Pit Below Seepage Pit Total Depth r
Applicable,/ Inlet (BI) ti�t� /
N/A Overburden factor 4ON5* I'9" 8/ r Max. towable Depth
No. 2 System IV
jl.!•
yREMARKS: �Y�1''t✓''i„�-�,'i ,/J�'J/ryGc.t,,y/w�tC/L.-ter. 4_0-v, i1� /:Jl%v �'j/,•7dv-�J-c-.c� C�a.(J�/.�- .
This appl'icatiorLrs�AP RP OVED NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan pan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z above -designed system. No construction is permitted in.the required reserved 100% expansion area. _
S 1) Septic tank and sewer lines must be 50' minimum from anywells / i� >,
U j Leach lines must be 100' minimum from any wells, including expansion rea rl
f Seepage pits must be, 150' minimum from any wells, including
/expansion area
Sianahvw of Hwa Rh CNfirial � /�t/LU.'z" 3.2V41 J
RECEIPT NO. 5_0 c:;Zy Issued By ,� Date 3' -X L4e 9
DISTRICT: ❑ Riverside, &o ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
City
State
Zip
Job Property Add
Legal Legal Description Prop. (PM, Tract, Lot)
oxL SRO,/t) C, -s
�A
97,4
s-331,4-J!'/Az.
Gare
i 83 _aAl
Lot Size
d_% ter_Agenc /Well-
4 lr&/'c.
Use of Permit P/P, CU, etc
Other
I rY,
Dwelling H Site Prep, etc.
i c.c
r 3
%..3 f >�9
I Signature of Applicant
�
Date
CATEGORY:. REV CODE FEE
CATEGORY:
REV CODE FEE
ET SUBSURFACE DISPOSAL 1238
$45.00
❑
SITE EVALUATION UPON REQUEST
7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
k,
(NO PLOT PLAN)
m
LAND DIVISION
❑
SEWER/SEPTIC VERIFICATION
7348 $11.00
Z
0
a. 1 st 4 Parcels (Each) 1238
$45.00
(Less than 1 year)
b. Each Parcel after 4 7344
$16.00
❑
PRELIMINARY ELECTIVE
7352 $45.00
u
W
❑ Rereview (2nd review same parcel) 7344
$16.00
EVALUATION (Attach DOH SAN 53)
to
❑ 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
�• INfTI,AL
DATE
y !1
Holding Tank Agreements Completed
❑ Yes
✓�T �.
❑ Noo�,
Certification of Existing S.D. System Required
❑ Yes
/
t
WOCB Clearance required. (Attach Form
❑ Yes
s"
❑ No
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required.
Special Feasibility Boring Report Required.
` ❑ Yes
❑Yes
No
m"No r
�'
Detailed Contour Plot Plans Required.(1.to 5 fL.interva)- _ ❑ Yes
o.",
Other
❑ Yes
OrN/Os
Staff Specialist Lot Inspection Required
❑ Yes
O
Lot Inspection Date
Soils boring report by i �/ Project # Date r
Soils Map Page ' A W Type �)�" Approved by "' e' JI'L Date
rr
U No. of Systems Type of System(.) No. Dwelling Units (/) (1) Septic Tank Soil Rate .,presse/Sand
Z ❑ Holding Tank ❑ Existing Bedmome, fbdw.r. lnitit ,,y !/' - / •Gftase Intcp
J :7'14ew ❑ ReplaoertreMD�/j
� T "���
� fff �''j Gal
U _ v v
to (2 trenchftttom t Sidewall allowance Install— L, Une(s) ft. 101V fr wide with -.Leach Bed sq. ft.
area ft rock/ sq. R min. .rches rocik dremlines or of per running ft.
�_
O!NA
Leachlines/bed special design for slope: (3) . Pit Diameter No. Pits Pit Below Seepage Pit Total Depth r
Applicable,/ Inlet (BI) ti�t� /
N/A Overburden factor 4ON5* I'9" 8/ r Max. towable Depth
No. 2 System IV
jl.!•
yREMARKS: �Y�1''t✓''i„�-�,'i ,/J�'J/ryGc.t,,y/w�tC/L.-ter. 4_0-v, i1� /:Jl%v �'j/,•7dv-�J-c-.c� C�a.(J�/.�- .
This appl'icatiorLrs�AP RP OVED NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan pan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z above -designed system. No construction is permitted in.the required reserved 100% expansion area. _
S 1) Septic tank and sewer lines must be 50' minimum from anywells / i� >,
U j Leach lines must be 100' minimum from any wells, including expansion rea rl
f Seepage pits must be, 150' minimum from any wells, including
/expansion area
Sianahvw of Hwa Rh CNfirial � /�t/LU.'z" 3.2V41 J
RECEIPT NO. 5_0 c:;Zy Issued By ,� Date 3' -X L4e 9
DISTRICT: ❑ Riverside, &o ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records