003325 (SFD)T4tyl 4�Q�rw
Building
Address 54-295 F4senhovrr
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing I
Address
City ' ]Zip _ Tel.
2253 1
Contractor
Address
State Lic. City
& Classif. • 335932 Lic. # .1047
Arch.,-Engr.,
Designer
Address Tel.
City Zip State
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 be.Business andel Profes'sions{Code, and my license is in full force and
effect. Azr/ W,ff/ ./:}.'
r 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,Bdsiness and Professions Code: Any city or county which requires a
permitto construct, alter, 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 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 civil penally of not'more than five hundred dollars ($500).
O 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. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve 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, 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:)
0 1 am exempt under. Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that Ihave 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 completed if the permit is for one hundred dollars ($100) valuation
or less.)
I 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 California.
Date Owner
NOTICE TO APPLICANT., If, after making 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.
No. 003325
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-252--015
Legal Description
Project Description .dingle Family Melling
Sq. Ft. 1550 No. No. Dw.
Size Stories. Units
New 1J Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT '
Plan Chk..Dep.
$250.00
Plan Chk. Bal.
S 61.02
Const.
394.00
Mech.
36.00
Electrical
80.68
Plumbing
103.00
S.M.I.
6.06
Grading
20.00
Driveway Enc.
20.002
Infrastructure
1,275.00
Issued by:
Date ermit
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-
TOTAL
52.245.76 S ,rF�Qa.�'fi ✓
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line'
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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
8/2018
read this application and state that the above information is correct.
Issued by:
Date ermit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation: -
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
B GRADE3 �•OUGH
PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
RMS Q/v C�
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. S0. FT. ®
I
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 .
TBACK
�eGROUND PLUMBI
,/L -y
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE3 �•OUGH
PLUMB.
_
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS Q/v C�
SEWER OR SP
7 j
, ROUGH WIRING J �$
DUCT WORK
ROCK STORAGE
OUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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.
IVFRAMING /a
FINAL INSP.
,/GOOFING _ r
rrinr..
2 �� 1 I.� a C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING OW
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
P.O. BOX 1504 • APPLICATION ONLY
Building 78.105 CALLE ESTADO
Address. 54-295 Eisenhower LA OUINTA, CALIFORNIA 92253
Owner
Mailing
Address P.O. Box 837
City Zip Tel.
La Quinta CA 92253
Contractor
ANTHONY SESTICH - A.M.S. Construction
CityTel.
Zi
La Quinta CA 2253
State Lic. beneral Contractor City
& Classif. 335932 Lic. q 2047
Designer Architect - John Robert Bund
Address P.O. Box 1575 Tel.
77-836 Montezuma 564-3363
City Zip State
I _ n..__- t` it nnnrn L1c.If rrn
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
701Kf) t. of Division 3 of the Business and Professions Code, and my license Is in full force and
elfec
_SIGNATURE DATE
O*NER•BUILDER DECLARATION
I 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, krprove, 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
Division 3 of the Business and Professions Code, or Mat. 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 cM penalty of not more than five hundred dollars (E 500).
O 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 improves thereon and who does such work himself or through his own employees.
provided that such improvements are not In fended or offered for sale. It, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of 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 apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Con rector's License Law.)
O lam exe turd Sec. P.C. for reason
Date Owner
WORKERS' COMPENSAT14 DECLARATION
1 hereby affirm that I have a certificate of consent to self -Insure, or a certificate of
Worker's Co Insurance, or a ce 1 c t reof. ec. 3800, Labor Code.)
Poor No. / U L U/ 1 Company rM t- u n
AMCopy Is tiled with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one hundred dollars (E 100) valuation
or less.)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any ppeerson in any manner so as to become subject to the Workers' Compensation
Laws o1 Calilornia.
Date Owner
NOTICE TO APPLICANT: It. after me" 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 shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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, Zlp
FINANCE
ILDING: TYPE CONST. , R-1 OCC. GRP. Single
P. Number
Lot S, Ii I OCK eVV
!gal Description Santa Carmel i to
oject Description Unit #26MB20/50 & #27MB19/82
Single Family Residence
Sq. Ft
Size
New [
1650. No.
1 Unitss
Add ❑ Alter ❑ Repair ❑ Demolition O
Estimated Valuation 55,000
PERMIT AMOUNT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
WA
TOTAL Z 7 -);7 o c>
REMARKS
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:
Dear Developer/Landscaper:
OFFICE OF
AGRICULTURAL COMMISSIONER
4080 LEMON STREET, ROOM 19
RIVERSIDE, CALIFORNIA 92501
(714) 787.2561
49-613 Hwy 86, Suite B-12
Coachella, CA 92236
(619) 342-8291
E. LEON SPAUGY
COMMISSIONER
JAMES 0. WALLACE
ASSISTANT COMMISSIONER
Thank you for inquiring with the Agricultural Commissioner's Office regarding
local quarantine laws.
Any diseases or insects associated with the plants/landscaping material presented
on your landscaping plans do not pose a threat to the Coachella Valley Citrus,
Date, Grape, Vegetable, or Field Crop industry. We therefore approve your
landscaping plans.
If however, any substitutions of plants/landscaping materials within your plans
occurs between now and the actual planting date, you must contact this office
within 48 hours before delivery into the Coachella Valley. Also, the substituted
plants/landscaping material must be held for inspection upon arrival. Any sub-
stituted landscaping material found infected/infested with quarantine pests will
be immediately treated or shipped out of the Coachella Valley at the discretion
of the Agricultural Commissioner's Office.
Under penalty of perjury, I the undersigned will comply with the above.
Authorized Agent:
Name 4,1Tf�4b�►�`� T��f Date 177�%�
r
Signatu �/ �e,� A_
Permit Number(s)
=1111 miniz
Deve
AGRICULTURAL COMMISSIONER'S APPROVAL
Authority cited: Agricultural Code; Sections 6301, 6461, 6462, 6464, 6501, 6521-
6524
cc: 2 Plan Check, Indio Office, Riverside Office
k
TO:
FROM:
DATE:
Z.*10�8r
T4ht 4 61
78-105 CALLE ESTADO -
All Permit Applicants
City of Le Quints,
February 9, 1987
LA QUINTA, CALIFORNIA 92253 - (619) 564.2246
SUBJECT: PROTECTION OF UNDERGROUND INSTALLATIONS AS MANDATED
BY AB 3020
Prior to the issuance of a permit which involves any type of
excavation, the Applicant must provide the City of La Quinta with an
"Inquiry Identification No." issued by a regional notification
center. The notificat on center for this area is:
_::
UNDERGROUND SERVICE ALERT
1-800-422-4133 7/ /
Excavation is defined as any movement of earth by grading, trenching,
digging, ditching, drilling, augering, tunneling, scraping, cable or
pipe plowing and driving, or.any other way.
1H:dev
cc: File, Underground Installations (Alpha)
MEMOTH6
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA -92253
Y I -r IL_- FE ':2 -1- f[ A 1'VI E-7 F--< C3 'v" inb L- C. Q-A t— sl -b 7 1 q -P trail 9-b rr--z il:z-: r -N 1 tTsI
JOHN H. HACKER, CIVIL ENGINEER, PALM SPRINGS 327-4565, OCEANSIDE 721-3721.
LATITUDE 33.0 WINTER TEMP . 31 DEG SUMMER TEMP. 1.10 DEG
NAME ------- A.M.S. CONSTRUCTION -
ADDRESS ---- P.O. BOX 837
CITY ---- -- LA QUINTA / CA 4061 3
REF.GAL.ENERGY CONSERVATION DESIGN MANUAL, FORM 2, HEATING LOSSES
MANUAL J FOR COOLING LOSSES
AREA BLDG 1650 SO. FT.
PERIMETER 181.333:; SO. FT.
INSULATION R VALUES .FLOOR 0 ..CEILING 38 ..WALL_ 19
AREA NORTH WINDOWS 48 SOFT. PERCENT OF AREA 2.909091
AREA EAST WINDOWS 56 SOFT. PERCENT OF AREA 3.39394 �
AREA SOUTH WINDOWS 121 SL?. F T. PERCENT OF AREA 7.331333 �
AREA WEST WINDOWS 41 SO.FT." PERCENT OF AREA 2.484849
AREA SKYLIGHTS 0 SO. FT. PERCENT OF AREA 0
TOTAL WINDOW AREA 266 SQ.FT. PERCENT OF AREA 16.12121
THE TOTAL S.C. OF THE WINDOWS IS 0.80
SOUTH OVERHANG LENGTH 2
INTERIOR THERMAL MASS AREA = 500 SQ. FT.
ATTIC AREA = 1650 SO FT
INFILTRATION (STD 0.018, MED 0.014, TIGHT 0.012) = .014
HEATING LOSSES
FOOTING LOSSES... 8600 BTU
CEILING LOSSES... 1629.11.4 BTU
WINDOW LOSSES.. .11411.4 BTU
WALL LOSSES.... 2284.195 BTU
INFILTRATION LOSSES... 7207.2 BTU
TOTAL HEAT LOSSES BTU/HR.. 305.39.91
GAS FURNANCE SIZE P620 1.89 BTU OR 45,000 0 BTU
COOLINGL_.OSSES
INFILTRATION LOSSES... 7392 BTU
FOOTING LOSSES... 8213.333 BTU
CEILING LOSSES... 1670.886 BTU
WINDOW LOSSES... 19981.69 BTU
WALL LOSSES.... 23.38.862 BTU
INFILTRATION LOSSES... 7.392 BTU
NO. OF PEOPLE... 5 COOLING LOSSES... 2000
KITCHEN... 1500 BTU
DUCT LOSSES INCLUDED IN TOTAL_
TOTAL COOLING LOSSES 43096.78 BTU
11COMPLIANCE CHECK LIST PER DESIGN DATA �~
SLAB OR FLOOR , -4 POINTS
WALL INSULATION, 0 POINTS
CEILING INSULATION, 0 POINTS
ATTIC, 4 POINTS
NORTH WINDOWS GLAZING 0 POINTS
EAST WINDO SGL -1 POINTS
p�.- - - � --
SOUTH WI��/vuu~SGLAZiNG `` -6 POINTS
WEST WINDOWS GLAZING ' ' 1 POINTS
SKYLIGHT GLAZING 0 POINTS
EAST SHADING
COEFFICIENT
-4
POINTS
SOUTH SHADING
COEFFICIENT
-2
POINTS
WEST SHADING
COEFFICIENT
-1
POINTS
NORTH SHADING
COEFFICENT
0
POINTS
SKYLIGHT SHADING
COEFFICIENT
0
POINTS
INFILTRATION -1 POINTS
THERMAL MASS 500 SQ.FT. 10 POINTS
SOUTH OVERHAND 2 FT. 0 POINTS
'
GAS FURNANCE 71 SE AND REFRIGERATION COOLING
THE EER OF THE COOLING SYSTEM IS 8.7
COOLING 6 POINTS
THE ALLOWABLE POINTS PER AB163 IS -4 FOR AREA 15
THE TOTAL POINTS ARE 2
THE FOLLOWING MANDATORY FEATURES/DEVICES ARE REQUIRED PERCAC TITLE 24
|
ELECTRIC RESISTANCE WATER HEATING NOT PERMITTED '
INSULATION AS SPECIFIED: PER MANUFACTURES LADLE
INFILTRATRION CONTROL. DOORS, WINDOWS FULLY WEATHERSTRIPPED
OPENINGS CAULKED AND SEALED AROUND JOINTS IN WINDOW AND WALL SOLE PLATES AND
ELECTRICAL OUTLET PLATE GASKETS '
MANUFACTURED DOORS SHALL MEET APPLICABLE STANDARDS |
BACK DRAFT DAMPERS ON EXHAUST FAN /
FIREPLACES MUST HAVE TIGHT FITTING, CLOSEABLE DOORS COVERING FIREBOX
PROVIDE COMUSTION AIR INTAKE DUCTS (6 SQ.IN.) WITH TIGHT FITTING DAMPER
DUCTS; BUILT PER CHAPTER 10 U.M.C.
GAS FURNANCE SIZED TO 1.3 DESIGN LOSS+10 BTUH PER SQ.FT.OR 45,000 BTU
SETBACK THERMOSTAT8*SHALL HAVE AUTOMATIC SETBACK CAPABILITY /2 PERIODS PER 24
WATER HEATER TO HAVE R-12 INSULATION WRAPPING, AND R-3 ON FIRST 5' OF PIP
NAT, GAS STOVES SHALL NOT HAVE CONT. BURNING PILOTS-
LIGHT
ILOTSLIGHT IN KITCHEN AND BATH TO BE FLOURECENT, EXCEPT BATH MIRROR KIT SINK, ALE
CERTIFIED BY ;_ ____________________'
)
_��
,
°
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development -
78-105 Calle Estado NOTICE:
La Quinta, CA 92253
THIS DOCUMENT CANNOT
BE DUPLICATED.
This is to certify t a (,l. /. [/ ,
developer of which is
located at dMtx-2 //6 within
this District, has paid school facility fees imp ed pur uant to the
authority generated by G vernment ode ctiolt 5 080 n the a ounti
$�t��'
covering a total of & �[) square feet of ( r idential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
for DESERT SANDS UNIF ED SCHOOL DISTRICT
White - Building Department • Yellow `- Facilities Planning • Pink - Accounting • Gold - Developer
�� l t (10)-37
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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 $37 is required when the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log #
Na (Owner, Agent, Contractor, E
rr�#
M Address
�v
City
State
Zip Code /r
Telephone
'Job Property Mdress
Legal Description of Property. (Lot, PM, 7 %
15,5A196W�2
�r�vrA
r Gi a z_
'Assessor's Parcel No.Water
Age r+rrWe#-4_/►
/
Use of Perm' ' /T L • Planning Case #
Lot Size
r
/,
SFp,.MH Site Preparation Etc.
Ze
Sign f Da
/ The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date p
Certification Existing S.D. System required. ❑ Yes
of
WQCB Clearance required. ❑ Yes ,
Soils feasibility report required. El Yes o
4ftsxe�}o I g repo (required. ❑ Yes o 1
Detailed contour plot plans required. ❑ Yes
LJ
SEl Specialist approval required. Yes No Lot Inspection Date
Soils/boring report by''',,� /% Project # Date c
Soils Map Page/ Soil Type C Approved by
Type of System:v
No. of Bedrooms
(1) Septic Tank
Rate Required
El Existing New E) Additional El Replacement
P11^ Ox.
��Gals.
/SSoil
(2)"Leach line sq. ft.
Sidewall allowance
Install Lines) Ft. Long, 161LeaccAtied
Sq.
(tab m trench area)
ft. rock/ Sq. Ft.
Ft. wi e 0 mien. inches
Ft. of butt nl.
per running ft. ®'I�I/A
rock below drain lines
area
Leach lines/bed-special design for slope:
Applicable
(3) Pit DiameterNo.
—Mir
Pits
Pit BI
f
Seepage Pit total depth N
Max. allowable depth S�0
N/A urden factor
Overb
-*�
10011
e derried.for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
This application i appaiive.
set ff h in Section A building permit i�necessary for the instal atio of theJ ab--o__ve-desi ped system.
1 Septic tank and sewer lines must be 0' from any wells
IL !/cuL
(2J., Leach lines must be 100' min. from any wells including expansloh area
lir
y
Seepage pits must be , 50' min. from any wells including expansion area % /� �� y t (,� • v+-ce « ��
Signature of Health Official I X
RECEIPT NO.— C24 da Issued by /eC�/� / Date 0 11 a 12'
District: ❑ Riverside Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. El -Blythe 41f
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
W1.
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