BRES2017-0108RECEIVED a�e�sa:o�7-0►08
County of Riverside
""DEPARTMENT OF ENVIRONMENTAL HEALTH
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co EVELOPMENT LAND USE APPLICATION —WV5t` -z-
OFFICE USE ONLY
3880 Lemon Street • Suite 200 • Riverside • CA • 92501 — (951) 955-8980.h�rk
-7570
-950 Ara Suite AIndioCA.92201 — (760) 863 47 121,
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-R/PM LOT # I USE OF PEFILT_,G
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3E'CTION �...;-
Name i' l,�,C, I ,'�/�
OWNER: Address ` l \ . f 1'� W Lr I CitVC
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Phone . / — ' �� ` Q Email 10 Urn 1' .. C'�Company Name ractcr
AGENT/.
CONTRACTOR: Mailing Address Cit` Zip
Phone Email 1 I
Site Address t� U Citi v 1 Zi
PROPERTY INFO:
rWater
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Agent//Well vyllf Lot Size J 1 2
APPLICANTS SIGNATURE: DATE:
t 4 rwe� , "r ,Below For OffceTtJse'On1Y.F�frt
SEC;TIO.N(B,.'���.�a.�,:.'.`,.,,�;.fH�}. ,...• �.....,..
CHECK BOX IF REQUIRED
If any box is checked. this application shall be considered denied until the information is provided.
❑ Holding Tank Agreements Required ❑ Floor Plan and/or Plumbing Layout Required
❑ Certificate of Existing OWTS Required`(C-42) ❑ Special Feasibility Boring Report Required
ElWQCB Clearance Required ❑ Detailed Contour Plot Plan Required (1 to 5 foot intervals)
Cl Soils Percolation Report Required
SITE EVALUATION INSPECTION REMARKS: -
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EHS INITIAL SIDA�c; pr �ij
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❑ NEW ❑ REPAIR/ REPLACEMENT EXISTING ❑ PUMP ❑ ATU ❑ CONNECT TO SEINER FIXTURE UNITS 4 BDRIVIS #--- `---
Soils Percolation/Boring Report By: Date: - Project#
cr— r2 Yk 35)8
Leach Lines/bed special design for slope: ❑ N/A ❑ Overburden Factor.
Pit Diameter. No. pits: Depth below Inlet (bi): I Pit Total Depth: tvtax. al'=owable depth:
CONSTRUCTION/INSTALLATION REMARKS:
.SECTION' D
This Application is Approved ❑ 0enied regarding rhe design of the OWTS as indicated on the accomoanied plot plan using the requirements set orth �in
Section C above. t o onstructi n is permitted in the required reserved 100°% Expansion area. /
EHS Signature: Da : t I
EPO -92 (RE`/ 7I16) v Diiinbution:'WHITE - Office File: ;(EL' -CW - Bldg. Cept. ?INK-.Aopiicant
C-42 Certificate n By: n '
TT
Date- I I
LicFse; Z
Septic tank cap.:
Soil Rate:
Tested Depth:
Max. trench deptn:
Sq. Ft Bottom Area:
Total Linear FL:
Line(s):
Len the feet - Each 3 feet wide
Sidewall Allowance: Ft. Rock/ Sq. ft. Running foot
Rock below drain line: in. or ❑ Plastic Chambers
Leach Lines/bed special design for slope: ❑ N/A ❑ Overburden Factor.
Pit Diameter. No. pits: Depth below Inlet (bi): I Pit Total Depth: tvtax. al'=owable depth:
CONSTRUCTION/INSTALLATION REMARKS:
.SECTION' D
This Application is Approved ❑ 0enied regarding rhe design of the OWTS as indicated on the accomoanied plot plan using the requirements set orth �in
Section C above. t o onstructi n is permitted in the required reserved 100°% Expansion area. /
EHS Signature: Da : t I
EPO -92 (RE`/ 7I16) v Diiinbution:'WHITE - Office File: ;(EL' -CW - Bldg. Cept. ?INK-.Aopiicant