Loading...
07384 (SFD)4 P.O. BOX 1504 Building 79-8€35 Fiesta711-105 CALLE ESTADO Address - • - LA QUINTA, CALIFORNIA 92253 Owner Steve Mi tdml l Mailing Address :pp Box 695 _ City Zip Tel. La Qidinta 92253 . Contractor Address State Lic. city 1£ Classif. I Lic. # Arch., Engr., Designer Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 effect. SIGNATURE DATE OWNERBUILDER DECLARATION I hereby affirpn that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usrmess and Pm1essfo+rs Code: Any city or county which requires a permit to construct, after, improve, dernofsh, or repair any structure, poor to its issuance also requires the MOcant for such permit to fie a signed statement that he is licensed pursuant to the provisions of the Canbacto#1s Lkvrmse 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. Army violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penally 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 Liiense 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. If, however, the building or Improvement is sold w&A one Year of completion. the owner -builder will have the burden of proving that he did not buil or irprove for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project (Sec. 7044, l;usimess and -Professions Code: The Contractor's License Law doesnot apply to an owner of property who jbuids or improves thereon, and who contracts for such projects with a conbactor(s) Evened pursrant to the Contractor's License Law.) ❑ 1 am exempt under Sec --------R I & P.C. for this reason Date •�''" � ) ` '��Owner �✓''���''���� /���.L �^'�.� 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. O 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 ($160) vatuatlon or less.) ,- I certify that in the performance of," work for which this permit is issued, I shall not employ any person in any manner so as to become sub" t=to„the,Workers' Compensation Laws oflCalifornia77�,w % t Date NOTICE TO AP 9, after maft this Certificate of Exemption you should become subject to the Workers' Cormpensafion provisions of the Labor Code, you must forthwith comply with such provisions or tlis pend 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, Chi Code.) Lender's Name Lender's Address This is abuilding permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 100 days. 1 certify that 1 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 relatingto 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 I No. 07384 BUILDING: TYPE CONST. OCC: GRP.- A.P. Number 617-113-005 Legal Description . L'Ot 68 Project Description SingU Family Dwelling Sq. Ft. 2455 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ stimated Valuation $134,270 PERMIT AMOUNT Plan Chk. Dep. ' • 00 Plan Chk. Bal. 2,72.77 Const. 762.00 Mech. 79.00 Electrical t 171.21 Plumbing 168.00 S.M.I. 5.45 Grading 20.00 Driveway Enc. 20.00 Infrastructure 3,021. fly# Fringed tae 3 151.56 TOTAL a• REMARKS r r.rc,rs�e i ? r.�1i •5 .P'%--.�Y♦ _6A ( A ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line t Side Street Setback from Center Line Side Setback from Property Line + FINAL DATE INSP.EcT/A9Ff Issued by: Date • Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS SLAB GRADE t�j �/9� ® ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. FORMS SEWER OR SEPTIC TANK 7T&ROILGH WIRING MOBILEHOME SVC. BAR SINK POR SQ FT ® GAS (ROUGH) ( S- O L METER LO HEATING (FINAL) GAR. SO. FT. ® POWER OUTLET ROOF DRAINS TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. WATER HEATER SERVICE WALL SQ. FT. DRINKING FOUNTAIN, SQ FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ LUMBER GR. FINAL INSP. t C WATER PIPING NOTE Not to be used as property tax valuation C/ •/l G FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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. SQ. FT. a c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® V 4c 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 t�j �/9� ® ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK 7T&ROILGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 3 GAS (ROUGH) ( S- O L METER LO HEATING (FINAL) OTHER APPJEQUIP. 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. t C FRAMING r 4;� FINAL INSP. ZG �d L ROOFINGS I40AIP VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL r CATH NG 3 70 r MESH //,, 1MR111 ATInhUen11MnA C/ •/l G 5 fD / REMARKS: FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL GARDEN WALL FINAL Building Address / D c&t!t 4 4 99m& P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing p/ Address PC sd �c T to City Zip Tel. Lea ©r 1 ; �n. 92253 Fi, 14 T. Z53 I '9Q-70/14 State Lic. City & Classif. I Lic. # Arch., Engr., Designer Address Tel. City ZipI State I Lic. # LICENSED CONTRACTOR'S DECLARATION I 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 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, alter, igprove, 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 Law, Chapter 9 (commencing with Section 7000) of 0tvLsion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any vrvlation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a cfvU penalty of not more than rive hundred dollars ($500). ❑ 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 Professions Code: The Contractor's License Law does not apply to an owner of property who builds or irproves 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 inprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not bufkl or nrnprove for the purpose of sale.) Iiial I as owner of the property, am exclusively contracting with licensed contractors to con- s ct 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. B. & P.C. for this reason Date — , viner WORKERS' COMPENSATION DECLARATION 1 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be 5aftdr ' the permit is for one hundred dollars ($100) valuation or less.) certify that in the performance o thg work for which this permit is issued, I shall not employ any person in anyas to become subject to t Work rs' Compensation Laws of Califo nta9 1 Date �wner NOTICE TO APPLICANJY,aking this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith cornply with 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 f the work for which thisYelrrtit is issued. (Sic. 309 7, Cp(�r�) fys/�/� Lender's Name 3S�T /—iQ vT= Lender's Address_, [700 "JV // This is a building permit when properly filled o t, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I car ity that I have read this lication and state that the above information is correct. 1 agree to comply with all cityd county ordinances and state laws relating to building construction, and hereby authgfnze representatives -of this city to enter the above- mentioned property for ins e i urposesk Signature of applicat�n�� / —Yom[ i.�' �C .0 Date Z—� �0 Mailing AddresaV r2i3QN City, State, Zip BUILDING DIVISION LDING: TYPE CONST. OCC. GRP. P. Number -Al-P 6/ 7 ��1i3 DO j :gal Description L p / . G GS oject Description S F 0 REMARKS _ 00511.82 i.0 2336 02-28-90 14 LU t.H 1 I IIS Y 4JV.tly 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: Sq. Ft. ZA Size / � No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ e/�t'[ii Estimated Valuation u n 9 7 f� PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. W'L77 Const. Mech. 7F, Electrical , 2 Plumbing , S.M.I. Grading Zp M Driveway Enc. Infrastructure 3,ozl, ti 6ri; c e F TOTALZ j b , t� 0 REMARKS _ 00511.82 i.0 2336 02-28-90 14 LU t.H 1 I IIS Y 4JV.tly 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 GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. 0�7 S0. FT. ® $ SLAB GRADE UNITS BONDING HEATING (ROUGH) STORAGE TANK 2ND FL. SO. FT. SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM Q GAS (ROUGH) METER LOOP MOBILEHOME SVC. OTHER APPJEOUIP. BAR SINK GAS (FINAL) POR. SO. FT. ® GROUT WATER HEATER SERVICE GAR. 2,.SO. FT. ® POWER OUTLET WATER SYSTEM ROOF DRAINS GRADING cu. yd. $ Plus -X$-=$ LUMBER GR. FINAL INSP. DRAINAGE PIPING FINAL INSP. CAR P. SO. FT. ® ROOFING �^ _ REMARKS: WALL' - SO. FT. ® VENTILATION - DRINKING FOUNTAIN SO. FT. ® FIREPLACE URINAL ESTIMATED CONSTRUCTION VALUATION $ - SPARK ARRESTOR WATER PIPING GAR. FIREWALL NOTE: Not to be used as property tax valuation LATHING FLOOR DRAIN MECHANICAL FEES` MESH WATER SOFTENER VENT SYSTEM -2.,-FAN EVAP.COOL HOOD FINISH GRADING SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER CERT. OCC. GARBAGE DISPOSAL FURNACq^NIT WALL FLOOR SUSPENDED INSPECTOR'S SIGNATURESIINITIALS LAUNDRY TRAY AIR HANDLING UNIT CFM GARDEN WALL FINAL KITCHEN SINK 17 ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET lea COMPRESSOR HP Qa POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT / SHOWER BOILER B.T.U. SO. FT. ®c 74(/7 BATH TUB 2 SO. FT. ® c Z WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1Ya c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING O PERMIT FEE s PERMIT FEE PERMIT FEE Is DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST, FEE ELECT. FEE SMI FEE PLUMB. FEE 7l ,52 77 762,00 /7/ Z/ l y� /6P, 00 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 COACHELLA VALLEY FRINGE -TOED LIZARD SECTION 10A MITIGATION FORM FROM: APPLICATION DATE: APPLICATION.FOR GRADING OR BUILDING PERMIT NUMBER ASSESSOR'S PARCEL NO(S). CITY OF LA QUINTA 2-Z8-90 ,(ol -p- - 113 - ooS ADDRESS (Name of Developer) has applied for a building/grading permit affecting acres. This proposal will require the payment of $ ( $600.00 X •ZS2 (10, acres) . By: Title We have received mitigation in the amount of $ ($600.00 X acres) in the form of cash on from Name of Developer By: BJ/FORM.006 Title o'i JO OFFICE OF AGRICULTURAL COMMISSIONER . ' AND WEIGHTS & MEASURES CALVIN C. KAMINSKAS JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Assistant Commtssionnr Agricultural Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE .Director of weights a Measures (714) 787-2561 Seater 49613 Highway 86, Suite B12 Coachella, Ca. 92236 DATE 2 - 27— %U (619) 342-8291 CASE NO. PC 01 27 96 DEVELOPER'S NAME: _ ADDRESS: d.�s �.cu,:.� . C.� q i i s� 3 TELEPHONE: Dear Developer: 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 from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural Corrmi.ssione Office cc: Indio and Riverside Office '. 2319-4 87-05226-21A T.O. �[ RECORDING REQUESTED BY CHICAGO TITLE COMPANY J AND WHEN RECORDED MAIL TO i NAie Mr. and Mrs. Stephen T..Mitchell P.O. Box 696 STRT ADDRESS La Quinta, California 92253 CITY 1b STATE L I GRj I 0 s oc '� c 8 W < .� Z r. � a I O s -� Q «• u ,�, W > :Y W c O X 0 �� tY _Cc W F' LL O g P �, C • 0 Oarm U W CrO Z �v _ _ IL —> W V SPACE, ABOVE THIS LINE FOR RECORDER'S USE LNT DEED (Individual) THE UNDERSIGNED GRANTOR(s) DECLARE(s) 27.50 TRANSFER TAX is $ g) . computed on full value of property conveyed, or -- - - 0. computed on full value less value of liens or encumbrances remaining at time of sale, arid" " FOR VALUE RECEIVED.dACK ANTHONY;VINCE and JANET ANN VINCE, husband and wife as point tenants. GRANT(S) to STEPHEN T. MITCHELL and KAREN E. MITCHELL, husband and wife, and MICHAEL I GEORGE MITCHELL, a single than, ALL AS JOINT TENANTS. the below described real property in the`state of California, county of Riverside city of u,r%,wcvr"`' I . -9 Lot 68, of Tract Riverside County, 7 SUBJECT T0:-. 2180, as shown by Map on file in Book 41, Page 39 of Maps, Records of California. 1. General and special taxes for the fiscal year 1987/88, a lien not yet due or payable. 2. The lien of'supplemental taxes, if any, assessed pursunt ato Chapter 498 of the State of California Statutes of 1983. 3. Any coveants, conditions, restrictions, reservations, rights, rights of way and easements of record. Tax Parcel No 617-113-005-2 Dated. June 8, 1987 cAAntlh�78_rn��"'�Fi'e T _to Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City of La Quinta DATE: Department of Community Development 8-105 Calle Estado La Quinta, CA 92253 NOTICE: TF 19S DOCU' TENT CANNOT L BE DDPLICATEDL This is to ertify that %V( yj developer of , which is located at , within this District, has paid school facility fees impose pursuant to the authority ge a ate b Gov rnment Code Sectio5t 5 0,60 in he mount o $ covering a total of squar feet of ( ) residential or ldv ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. � x/355 for D SERT SANDS UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 s4�n ,r-s�:%f. %S`i .-�F.. 5w:"',"•;P�{,,t7r �{-� r—,'��.:,�i:w.. ,...-:..:..;q,� n�ss`vrw••.,.irvY�rgf'�*•r.:':M: ua<r4tY'q.'-� ...,.�-: � s vr.,stilry '�-` �� � r �.. -- :,�. �� i" , r 7'" lltF�.r:0.". '-ve',r•' I'� ' as � - Q Z O ~U LU CO M Z O U W U Z O_ ~3 LU (n r COUNTY OF RIVERSIDE ENVIRONMENTAL ism NO' HEALTH SERVICES DIVISION 14/7— 113 — 609 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 # a Agent Contractor, Contact Person Phone Address & Firm L �- , City —1 State K# L Zip Z22S31 Job Property Address 79.0 /S f E57�V 4 Legal Description Prop. (PM, Tract Lot) 1,. Go 7-, 6p r Z /Po Lot Size =ter Agency i= Use of Permh P/P, CU, etc. Other 0 C (,J el , M Srt' a Prep, etc. % �(�rP.dr 2- 28 Signature of ApplicanF Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE 1� � S� UBSURFACE DISPOSAL 1238 $ 57.00 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a 1 at 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 DOH SAN 53) ❑ She Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7348 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ She Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 INITI U Holding Tank Agreements Completed ❑ Yes R Not /� T 9y Certification of Existing S.D. System Required ❑Yes © No,..• WQCB Clearance required. (Attach Form ❑YesNo DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes PNo-�' Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes ' Otter ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes / Lot Inspection Date Shca boring report by Date p / f a(p �L/ Soils Map Page Soil Type Approved by Date No. of Syslems T of System(s) No. Dwelling Units(/) (1) Septi: Tank Soil Rate Grease/San/ ❑ Holding Tank ❑ Existing ±New ❑ Replacement Bedrooms,-Rxtnret! fts 3 01-9 c� ///,� AYH �c a ` ©V I � 'O� u O2 G� / Gy (2LLsach Line Sq. Ft Bdltrench area Sidewall allowance Install L.iinee(�(s) fl. long ft wide withLeach Bed sq. tL ft rock/ _ sq. R per running fL min. inches'r�dk, _ kirainlines or ' bo tom area '"�\ Leachlines/bed special design for slope: Applicable (3) Pit Diameter r No. Pits �[// Pit Below Inlet (Bli Seepage Pit Total Depth (TD) ��61 Max. Alb)wgbQ pepth NN A'�'/ Overburden factor 6 /` , J„ No. 2 System A1/4 Sr' /l� tee'! •�-T�s� H /�s`-rX �+ �n. ��,,yy��--Q — n REMARKS:)vU&& 9 //1117 This application is�:O NiE� the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompansing 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 100% expansion area. 1( Septic tank and sewer lines must be 50' minimum from any wells qy /0 'j� � � • ' Leach lines must be 100' minimum from any wells, including expansion rea (3 Seepage pits must be 150' minimum from any wets, including expansion area /Q � � em, Poo;;, �N � Signature of Health Official ( ciLir ,C /LTJ Date rte+• - .dar RECEIPT NO. ! Issued By Alalz_ Date c -P r,w DISTRICT: ❑ Riverside, t7oQip ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records C 7 7l. 30 ft 142