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05012 (SFD)Contractor Legal Descnptlon Project Description A _ i' _ n _ Address - ' City ""j`" Zip Tela - State Lic_ City & Classif- 476007 Lic. # 56G y - Sq. Ft. 2 13i3 No. No. Dw. Size Stories Units ` Arch., Engr:, ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CO CTOR'S DECLARATION I hereby affirm that I am licensed un r DrovisionsC Chapter 9 (commencing with Section 7001) of Division 3 of the Business ai Professionde, and my license is in full force and effwcc/ / /�� L�7 � - - SIGNATURE .•'—/ rr A fi-7 / I"! ±.tj' DATE 4T u e F / OWNER-BW06Fn I1FC1 AnAT10N I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,0usiness and Professions Code:-"Any..City or county which requires a Permit to canslnrU, atter, kWmve, 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 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 exenpSan. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civipenally of not more than rove 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 reproves thereon and who does such work himself or through his own employees, Provided that such improvements are not intended oroffered 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 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, ro an owner of property who builds or improves thereon, and who contracts for such projects with a cantractom(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 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 completed N the permit is for one hundred dollars ($100) valuation or less.) 1I certify that in the performance of the 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. tl, after making this Certificate of Exemption you should become subject to the ftrkers' Cortpensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall 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 Lenders Address This is abuilding permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify 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 Ltsumaiea valuation $113,818 113s818 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Princy.P.-•-Tot,d L TOTAL AMOUNT 2.519.21 REMARKS " w WI -11 3 lI� <Ge`.t a ytY�tiif air ZONE: BY: P.O. BOX 1504 N o 05012 Building Address 79-'820 Horseshoes 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 - . IIAN ADEQUATELY SIZED DEBRIS %CONTAINER. OwnerON Side Street Setback from Center Line _ Side Setback from Property Line IS REQUIRED THE !DB-SiT E DURING FINAL DATE Don Howard nr�t�j�%Cal N 11 BUILDING: TYPE CON Pf4,D`, -si '� 66%&;GRACT Mailing A.P. Number 1fs ft7-P I2�-I�i ,� City Zip Tel. - " Contractor Legal Descnptlon Project Description A _ i' _ n _ Address - ' City ""j`" Zip Tela - State Lic_ City & Classif- 476007 Lic. # 56G y - Sq. Ft. 2 13i3 No. No. Dw. Size Stories Units ` Arch., Engr:, ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CO CTOR'S DECLARATION I hereby affirm that I am licensed un r DrovisionsC Chapter 9 (commencing with Section 7001) of Division 3 of the Business ai Professionde, and my license is in full force and effwcc/ / /�� L�7 � - - SIGNATURE .•'—/ rr A fi-7 / I"! ±.tj' DATE 4T u e F / OWNER-BW06Fn I1FC1 AnAT10N I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,0usiness and Professions Code:-"Any..City or county which requires a Permit to canslnrU, atter, kWmve, 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 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 exenpSan. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civipenally of not more than rove 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 reproves thereon and who does such work himself or through his own employees, Provided that such improvements are not intended oroffered 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 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, ro an owner of property who builds or improves thereon, and who contracts for such projects with a cantractom(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 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 completed N the permit is for one hundred dollars ($100) valuation or less.) 1I certify that in the performance of the 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. tl, after making this Certificate of Exemption you should become subject to the ftrkers' Cortpensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall 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 Lenders Address This is abuilding permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify 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 Ltsumaiea valuation $113,818 113s818 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Princy.P.-•-Tot,d L TOTAL AMOUNT 2.519.21 REMARKS " w WI -11 3 lI� <Ge`.t a ytY�tiif air 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 212�fs� Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL. SQ. FT. DUCT WORK ROCK STORAGE ' UND. REINF. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® REINF. STEEL (FINAL) zk TEMP. POLE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS WATER HEAT R SERVICE FINAL INSP. DRAINAGE PIPING CARP. SQ. FT. ® WATER SYSTEM GRADING cu. yd. $ plus x$ WALL SO. FT. ® LUMBER GR. DRINKING FOUNTAIN SQ FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ REMARKS: WATER PIPING NOTE: Not to be used as property tax valuation 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 SPARK ARRESTOR LAUNDRY TRAY AIR HANDLING UNIT CFM GAR. FIREWALL 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. SQ. FT. ® c BATH TUB FINISH GRADING SQ. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 4D PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE/ / f ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC tZ ROUGH WIRING DUCT WORK ROCK STORAGE ' UND. REINF. GAS (ROUGH) ,//METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL (FINAL) zk TEMP. POLE GROUT WATER HEAT R SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. Cf / ( FRAMING 'f FINAL INSP. ROOFING IZ L17�'01 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 4,.4Q91AS 5,7,,1 qs P.O. BOX 1504 APPLICATION ONLY Building �J O / �O � � /06 7&105 CALLS CALIFORNIAESTAD9 Address / f� > LA QUINTA, ORNIA 92253 O �q 4 A- If � Mailing _ Address! Cit-101_1 � ZIp Tel. �� n 7 �� S`S� 7_ 2---rI rol 11LDING: TYPE CONST.—OCC. � �()jOCC. GRP. P. Number ( / Z '7 � —%) / Description t Description � F S -�f`_s -62 zf o? State Lic. City & Classif. �� – Lic. # Sq. Ft -4 Size Z Arcn., tng Designer l �� �C l7�/L Address I Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 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 OWNER -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, bnprove, 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 prov-cions of the Contractor's License Law,. Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a* permit subjects the applicant to a crud 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 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 sod wfthim one year of completion, the owner -builder will have the burden of proving that he did not build or knprove for.the purpose of sale.) ❑ 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 propetty,who builds or improves thereon, and who contracts for such projects with a contractors) 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Coda.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. - 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.) 1 certify that in the performance of lhp 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: N, atter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such Proviskms 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 abuilding 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 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 No. Stories No. Dw. Units NewX Add ❑ Alter ❑ Repair ❑ Demolition ❑ oeD TOTAL V o9 31129– REMARKS '{ 9 d Sri /02 0 1S 00518'2 10 34 12- 2'1 _ 10 CASH i JUIAL 1 . � •:, ; Estimated Valuation 01 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 PERMIT AMOUNT , Plan Chk. Dep. .9 SO. QO Plan Chk. Bal. J7 Const. r: , 00 Mech. - 3 VV Electrical Plumbing S.M.I. Grading 00 Driveway Enc. Infrastructure Z2.vd oeD TOTAL V o9 31129– REMARKS '{ 9 d Sri /02 0 1S 00518'2 10 34 12- 2'1 _ 10 CASH i JUIAL 1 . � •:, ; 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 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM FOR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO. FT. OTHER APPJEOUIP. REINF. STEEL WALL SO. FT. ®- - DRINKING FOUNTAIN - SO. FT. ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation, WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ILAUNDRYTRAY 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 SPARK ARRESTOR SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LATHING SO.FT.GAR ® 3/ec HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATION/SOUND PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE:t�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 ROCKSTORAGE 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 of I ICE OF AGRICULTURAL COMMISSIONER AND WEIGHTS & MEASURES 49-613 Ilwy 86, 8ulte D-12 'Coachella, CA 92236 619-342=8291 E. LEON SIIAUGY CO�nnS�tO'•EA )ANIES 0 W;; LACE. ASSISIA-M r).�1NtSSIU�ER CLEMENT BEMIENISIE RAM DATE , �L 0-) 1M 1 CASE 1J0. R -' y, C)IV 0-7.c DEVEWPER' S NM1Es!)) k 40 � S /\ nDDMSS �; I Iyu� ,SII C lLti� TELE1'IIONEt Lql 3 1-1 15 - bear Dear Developers After reviewing your lanoscapli q plans, all plant material listed is not in violation of quarantine laws governLty the Coachella Valley. if substitutions do occur and they differ Erun plant material listed, this office must be notified immediately. Thmik you for protecting and preserviulg the Coachella Valley's pest -free environivent. Agr ural CamEun ssioer s VE r ice cco Indio and Itiverside O[fice M Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City fMjg4iQ a�� ,D4 Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 f - DATE: K,yJ l�y,H This is to certify that L-f� /7���`�`'� developer of which is located at oZ within this District, has paid school facility fees imposed pursuant to the authority, uthority, ( acro / •eneSethe `t/ �-- covering a total of are feet of ) residential or ( ) industrial/commercial development and that bui ding permits for this footage in this development may now a issued by your jurisdiction. 0T r D SERT SANDS UNIFIED SCHOOL DISTRICT White - Building Department 0 Yellow - Facilities Planning • Pink - Accounting 0 Gold - Developer m Z O U W W Z Z H L U. Cr ra COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. 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 checklist 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'!t Agent, Co ctor, Contact Person Phone Address & Phone _ r A !� Phone Mailing Address �- Eity-T State Zip Job Property Add Legal Description Prop. (PM, Tract, Lot) 70T/-6 7;,e4c ,f -v Lot Size Agency/Well Use `f Permit P/P, CU, etc. Other / /(J 7a gWater C f� - lG. Dwelling, MH Site Prep, etc. Date Signature of Applicant CATEGORY: REV C • DE6?-FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIALDATE Holding Tank Agreements Completed ❑ Yes O No l Certification of Existing S.D. System Required ❑ Yes O No WOCB Clearance required. (Attach Form ❑ Yes i I No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes I No Special Feasibility Boring Report Required. ❑ Yes 2 No Detailed Contour Plot Plans Required (1 to 5 ff. interval) ❑ Yes No Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by �-� Project # Date Soils Map Page Soil Type s' Approved by JJ Tr Date / 2 2 / No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Existing Bedrooms, Fixture Units Greas�ilirtcp ',�D New ❑ Replacement T`\ •i1kC<\i ICLGal 1 / Gal (2) Leach Line Sq. Ft Sidewali allowance Install I Lines) (--% R long ft wide with Leach Bed 1. Bottom trench area rl Z ft rock/ sq. R running ft min. � rock below drainlines or / of bottom/area J per ❑ NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage it Total Depth Other.T Applicable / / / Inlet (f31j ❑ 5 ❑ 6 Max�Mlowable Depth N/A Overburden factor No. 2 System REMARKS: ttik(� I'A'ck This applicati6n i APPROVEDYDENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan. ed plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above-designetl system. No construction is permitted in the required reserved 100% expansion area. I (1 Septic tank and sewer lines must be 50' minimum from any wells 1 Leach lines must be 100' minimum from any wells, including expansion area (3) Seepage pits must be 150' minimum from any wells, including expansion area (� � � Signature of Health Official %'i`"'��1 l Date RECEIPT NO. A U Z 8 Issued By T. T Date DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE-- Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records a-'