HomeMy WebLinkAboutpitkin.eh.246213301008 (1977)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
communications
As -built Design
Engineer Design
Soil Information
Floor Plans
Water Permit & Information
Land Use Approvals
Second System on property
Third System etc
(All relevant older documents in the same order as above)
(A red sticker will be placed on both sides of the file tab when doc. is scanned)
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PITKIN COUNTY HEALTH DEPARTMENT
W-01-00g
PERMIT NUMBER 7C��1 RECEIPT NUMBER .22 LJ
Owner \ \tA `y\(v Phone No.
Owner's Mailing Address VC) \sok \\((,z
Contractor
Address
System's Contractor's Name
Phone No
Address
Legal Description �C%T n
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Lot Size - Z C
Type of Building by Use.� C -cc rffN/4, y e5rivc r
Number of Bedrooms \ , Type of Water Supply W72/ WCLL-'f SP.Q/i/C(SU�V/sR)
Owner's Signature Date 2g,1-2
PLOT PLAN: ATTACHED AS REQUIRED
•M -*4r rr 11 .A,***.**.*a.aM*.***.i*i****a****Ir IFY*****rli Mr.*if*-*********i a it#*. M M t** M t e. Y 4. fM
Type of Individual Sewage Disposal System -2CPI L 1/1&'K - �) E /
Type of Soil or Soil Classification,,, //L, /-y LCAi!! TC L/i ,Ly --vProximal Location of Bedrock /liar (%F7EtiN1/A/i—G, c�IAT�/�
Proximal Location of Ground Water Table /VDT /7ETF�M//LtIJ—
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Percolation Test Date Minutes
Minimum Recommended Absorption System Size le
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Inch =4=
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Minimum Recommended Tank Size -Zen', iii/ Ni — /L�%t C70/✓/`��CZ-14 /(, rS
Special Conditions of Issue: NOTICE
Mr When properly signed for issuance, this application
C> % & /-Cell TIE beeomes your permit. Application valid one year from
tle'a. If an individual sewage disposal permit la Issued
oproperty, on which no building pxmit has been
_ issued, the individual sewage disposal permit shell
LL11q / C� L�il/� / //� N/-) 10 �/ F��1M expire 120 days after its issuance If conetruction has
/-� L �r Ty L - not been commenced. Any change in plans or speci-
F- /,A/!5 fications after the permit has been Issued Invalidates
Approved for Issuance By
.l the permit, unless approval is secured from the Health
/ Officer for such changes.
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FINAL INSPECTION APPROVAL_ / Date 3/�/ 77
(Drawing of System el+$aek)
On WEEMCheg P)Aplar)
PITKIN COUNTY ENVIRONMENTAL HEALTH
�,F,ield Test Data Sheet on Percolation Test 07
PROPERTY OWNER /// /h��`L� /l�� PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 hour soak
LD%
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop
Time
Drop Time
Drop Time
C
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25
L
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Z:
Percolation Hate Each Hole
Average Rate _
Comments on soil or site:
C&L� .P
Signature r
Date
7-7
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WORTH
LOT 8
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$ �x 53& r
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