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06743 (SFD)4 4vaumrw Building Address ( 53"345 Villa LA Owner pian L. White Mailing Address 10 S. 'O"Aingy St.. City Zip Tel. EAc-godide 9202-S' Contractor Address I3 v�,n City Lic. # Estimated Valuation i8$a39$ PERMIT AMOUNT Plan Chk. Dep. $230.00 Plan Chk. Bal. $ 252.07 Const. 590,00 Mech. 53.50 Electrical 109,90 Plumbing 157,50 S.M.I. 6.23 Grading 20,00 Driveway Enc. 20,00 Infrastructure I,875.25 TOTAL $3,334.45 •'.+s �`, r-/ � .REMARKS P.O. BOX 1504 7&105 CALLE ESTADO IUINTA, C.ALIFOR..NIA 92253 355 Capon St., -Suite D City Zip State da . Lic. # {q LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I:arnticensed under provisions of Chapter 9 (commencing with Section 7000) of Divi§ion 3 of the Business and Professions Code, and my license is in full force andy effect_ -T'^ r rt�r Ox SIGNATURE :/�. - 1:. Q DATE OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business 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 rile a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or aivisron 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 rive hundred dollars ($500). 0,1, 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 Proresskns Code: The Contractor's License Law does not apply to an owner or 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. If, however, the building or improvement is said within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose or sale.) O 1, 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 appty 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company O Copy is filed with the city. ❑ Certified copy is hereby -furnished.. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed .it the permit is for one hundred dollars ($100) valuation or less.) 1 certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califomia Date Owner NOTICE TO APPLICANT: H, alter making this Certificate or Exemption you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply wiM such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. ' I certify that I have read this application and state that the above information is corecL I agiee to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city .to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City,. State, Zip No, 06743 BUILDING: 'TYPE CONST. OCC: GRP. A.P. Number 774--093-018 Legal Description Project Description sxli Sq. Ft. �$Q No. No. Dw. Size • Stories Units.. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition'❑ Ss wr iay63ii I i4t�s'+a... 1 a/�}4.i•V �'i _ State Lic. & Classif. Arch., Engr., Designer. • Design Assoc. Address- Tel. I3 v�,n City Lic. # Estimated Valuation i8$a39$ PERMIT AMOUNT Plan Chk. Dep. $230.00 Plan Chk. Bal. $ 252.07 Const. 590,00 Mech. 53.50 Electrical 109,90 Plumbing 157,50 S.M.I. 6.23 Grading 20,00 Driveway Enc. 20,00 Infrastructure I,875.25 TOTAL $3,334.45 •'.+s �`, r-/ � .REMARKS P.O. BOX 1504 7&105 CALLE ESTADO IUINTA, C.ALIFOR..NIA 92253 355 Capon St., -Suite D City Zip State da . Lic. # {q LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I:arnticensed under provisions of Chapter 9 (commencing with Section 7000) of Divi§ion 3 of the Business and Professions Code, and my license is in full force andy effect_ -T'^ r rt�r Ox SIGNATURE :/�. - 1:. Q DATE OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business 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 rile a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or aivisron 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 rive hundred dollars ($500). 0,1, 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 Proresskns Code: The Contractor's License Law does not apply to an owner or 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. If, however, the building or improvement is said within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose or sale.) O 1, 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 appty 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company O Copy is filed with the city. ❑ Certified copy is hereby -furnished.. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed .it the permit is for one hundred dollars ($100) valuation or less.) 1 certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califomia Date Owner NOTICE TO APPLICANT: H, alter making this Certificate or Exemption you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply wiM such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. ' I certify that I have read this application and state that the above information is corecL I agiee to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city .to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City,. State, Zip No, 06743 BUILDING: 'TYPE CONST. OCC: GRP. A.P. Number 774--093-018 Legal Description Project Description sxli Sq. Ft. �$Q No. No. Dw. Size • Stories Units.. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition'❑ Ss wr iay63ii I i4t�s'+a... 1 a/�}4.i•V �'i _ Issued by: Date Permit Validated by: Validation: % 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. 12/i2189 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE �y QO ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMSdl-44049M-OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK FOR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE 212 DRAINAGE PIPING CAR P. SO.FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN SO FT ® WATER SYSTEM FINAL INSP. 7 3J w URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation p� ROOFING &44 Mel* /may[ * FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 MESH SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL FINISH GRADING SO.FT.GAR ® 3/ic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FIL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK /y qQ jff?OUN PLUMBIN O UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �y QO ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSdl-44049M-OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. l� c GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE 212 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. 7 3J w FINAL INSP. -?cu. 3 Ad GRADING yd. $ -Plus-x$-=$ LUMBER GR. FRAMING 3 23/���,` / p� ROOFING &44 Mel* /may[ * ! p i'fv/ i{� n 0 W REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHINGt--W/V �/� a 40 MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 4 P.O. Box 1504 APPLICATION'ONLY Building �� ,f �' 7&105 CALLE CALIFORNIAESTAD9 Address . LA QUINTA, ORNIA 92253 ` Address �) Q City BUILDING:, TYPE CONST.. - OCC. GRP. - G 1 S -r r A.P. Number -r74 03s04�+—G Tel. L! -74�5 .0661 Legal Description _ Project Description -- _ Address, . ,. . q. 11 - - ._ ity ' Zip Tel.. " ,,State-Lic:— __ ___T City._..__ 8 Classif. Lic. # Sq. Ft. No. No. Dw. - Size - Stories Units• - .Arch., Engr., DesignerI �2M N New ❑ Add ❑' Alter 0 Repair ❑ -Demolition ❑ , Address Tel. City _ _ _ _ Zip State q Lig.. # LICENSED CONTRACTOR'S DECLARATION -- 1- 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of, Division 3 of the Business and Professions Code, and my license is in full force and - - - j effect. SIGNA711RE DATE S -^ - OWNEWBUILDER DECLARATION- - - - - Estimated Valuation hereby affirm that I -am exempt from the Contractor's License Law for the -following - reasom' (Sec-, 703115,8usirress and Professions Code: ,Any city or county . which requires:: a - - •pemit.to construct, after, -improve, -demolish, -or repair any structure, prwr-to ins -•issuance -also:. requires theapplicantfor such permit to We -a - signed statement that he is licensed pursuant to • - -• - PERMIT- _ _- --, - - - -• --AMOUNT- the provisions of thit Contractor's License Law, .Chapter 9 (commencing with Section ,7000) of Division 3 of the Bus ness 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 Plan,Chk. Dep:; - - •J. �0. - _ subyects the applicant to a dirt penally of not more than five hundred dollars,($500).- Chk. Bal. ❑ 1, as owner_of.the property,.or my employees.with.wages as.their sole, compensation, .will—_ ,_.Plan do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and ' COr1St. Rotessions Code: The Contractors` License Law . does not. apply to an owner of property .who - _ buftft•or iromves thereon, .and•, who :•does• such ..work_himself.or,through:,his. own -employees,.— ,-.Mech: providert-that•such improvements are not -intended -or offered for -sale: lf, however, -the -building or 6rproverrlent is said within one-year of completion, the owner -budder will have the boder '—ofp16odsathedid not build .orimprove -for the .purpose ofsale.)-•_� —___ Electrical ••' r ' ` O, as owner of the property, am exclusively contracting with.licensed contractors to con- Plumbing. . „ strict.the proj ,(Sec.7044,_Buslness and Professions Code: The Contractor's License Law does not apply an owner of property =olio-.bcnlds or improves : thereon, - and who - contracfs for S. M. L-' "—' " - "` ' ' - _ ..� _ _ _ _ ..• _ such Teds a abac") 8censed pursuant to the Contractor's License Law.) ❑ I am ex t under - B& P.C..for t is re _ on _Grading _ Driveway Enc. -4 Date Owner-- Infrastructure _ WORKERS' COMPENSATION DECLARATION .:, r —1 hereby affirm -that. have a certificate.of consent -to -self-insure,.or.a,certificate of.;.. Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) •_ _�_ «.. _ _ _ � .. __ _..-f..._ — Poliq No - .Company_" _... _ 3.3 3 Ly r •"" ❑ Copy -isfiled-with-thecity. —❑ Certified copy is hereby-fumished:---- -- - TOTAL 7 OD CERTIFICATE OF EXEMPTION FROM ' WORKERS'COMPENSATIONINSURANCE REMARKS -ter `,;� �rSA 4@t3 (!Iris -section need' not be completed ' N the- permit is for one' hundred dollars ($100) valuation ` C H i T Q'T' AL - i • ' ? f `-> >00 or less.) • I certify that in the performance of the work for which'this permit is issued, 1 shall not !� emPloy any person in'any manner so as'to become subject to the Workers' Compensation Laws of California - ..- .. . Date - .. - Owner S NOTICE TO APPLICANT: ff. after making this -Certificate -of ;Exemption you should become ZONE:- - BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith- comply with such provisions or this permit shall be deemed revoked. • - - - - - Minimum. Set back Distances:' ... Front Setback from Center Line _ ' Rear Setback: from Rear Prop. Line - - colisrnucnoN LENDINCACEivcy +t` Side Street Setback from Center Line 1 hereby'affirn that'there is'a construction lending agency for the performance of the work for which this permit is issued_. (Sec. 3097, Civil Code.) Side Setback from Property Line � Lder's 'Name �Q&c Lenders Address This is a building permit when property filled but,"signed and validated, and is subject to FINAL DATE _ INSPECTOR expiration it work thereunder is suspended for 180 days. I'certity that I have.,read'this application and state that 'the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date _ Mailing Address - - - ' Validation: - City, State, Zip - BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES N0: PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SFKLR 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. FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ -$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/e c SEWAGE DISPOSAL SO.FT.GAR ® 3/.c HOUSE SEWER FINISH GRADING 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL �y '.'i'�` y47ir �s � ✓P�' �'Y7NGIY ^'�Qf COUNTY OF RIVERSIDE ENVIRONMENTAL �O� Ps"N" NIX SERVICES DIVISION O9k3 _ c) O I e �' HEALTH ; 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 & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #4'°^d w ,, t, Contractor, tact Person Phone -C awl a4 Address & Firm 6 Js C L'Q . Qw U A� W H I 1�- 9hgrie _ ' ail® AddCresa City Sts a Zip Job Property Address Legal D ription Prop. (PM Tract Lot) Lot Sizgf ' ter Agency Use of Permit P/P, CU, et".' Otho �1,%(• �. _ /�' 1F��4<�P C�' etcjLh�l� 'Prep, Signature of Applicant Date CATEGORY: REV CODE CATEGORY: REV CODE FEE C SUBSURFACE DISPOSAL 1238 $ 57 0 ❑ EVALUATION UPON R =QUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME _-SITE (NO PLOT PLAN) LAND DIVISION - ❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00 a .1st 4 Parcels (Each), 1238 $ 57.00 (Less "than 1 year) b. ' Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 . ❑ Rereview.(2nd review same parcel) 7344 $-24.00 EVALUATION (Attach DOi.,-i SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 '$111:00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 ❑ Site Evaluation Lot Less than SYSTEM 10,00.0 Sq. Ft. 7347 $ 87.00 ITIA DATE �N,,' Holding Tank Agreements Completed ❑ Yes F2 7" Certification of Existing S.D. System Required ❑ Yes WOCB Clearance required. (Attach Form ❑ Yes DOH SAN 007, Santa Ana Region Only) ;CNo,. Soils Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes N Other ❑ Yes 'Staff Specialist Lot Inspection Required ❑ Yes !?J No Lot Inspection Date Soils boring report by ProjectDate Soils Map Page 1 Sal Type Approved by �!/tr-- Date No. of Systems TY46 of Sy -t - N.) ❑ Holding Tank ❑ Existing No. Dwelling Units ( 1) Bedrooms, extam-.0 (1) Septic Tank Soil Rate Greage/Sand m 1 New! ❑ Replaoafxit its�_y —e Q /Z hi}�( �N reaee Intcp [LCiel Rj Leech Line WFt om trench area . S' Sidewall allowance _ ft rock/ - sq. R running ft Instal Lines) R long ft wide with min. -rock below dreinlines or Leach Bed sq. ft. om area per Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet Seepage P' Total Depth (TDj` / Applic�ble�� � (BI)/ Max. AIlowe�ble Depth N/A Overburden factor No. 2 System t REMARKS: /04 0 i This application i PROVED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit -s necessary for the installation of the e- designed system. No construction is permitted in the required reserved 10096 expansion area. abog3) Septic tank and sewer lines must. be 50' minimum--from-any wells Leach lines must be 100' minimum from anywells, including expans ar Seepage pits must be 115,,C' minimum from any wells, including expansion area Si nature of Health Official . .ate RECEIPT NO. � U Issued By 7`k /,"z- Date DISTRICT: - ❑ Riverside,Indio ❑ Hemet 17 Perris ❑ Rancho Calif. ❑ --Blythe DOH -SAN -122 (Rev 7/89) DISTRIBUTION: WHITE - Office file YELLOW Applicant PINK - Bldg Dept GOLDENROD - Plans/Records ti a FP