HomeMy WebLinkAboutpitkin.eh.246314401005 (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)
2116 3 -/4+ - DI-eoS-
PITKIN COUNTY HEALTH DEPARTMENT
PERMITN�U%M)BER RECEIPT�NUMBER c�s
Owner / ' / /G f///� L� 6' 2-ZinL5 - Phone No. 4—w / V,5
Owner's Mailing
Contractor
Address C /,?5( 0,7
System's Contractor's Name
Address (//-)/ 1--6 C
Legal Description Ld I
MA
Phone No.
Lot Size Type of Building by Use
Number of Bedrooms Type of Water Supply -
Owner's Signature _ Date
PLOT PLAN: A CHED AS REQUIRED /
o S--/
Type of Individual Sewage Disposal % 0 G -
System Jf �e /ANC — �Et AAC�E r/T
Type of Soil or Soil Classification
,,� 6 4Y LqC/RL t4GL/U! V1OM ARP,Les TSiQ C yec-
Proximal Location of Bedrock No -r DE -7-c w, Ai ep 4� 1q'r,5-,e %td9n� //,)-TrT
Proximal Location of Ground Water Table Alar pc7r�/NED-I�ZPE 7zx 7-HA4 1Z 1--7-
Percolation
T
Percolation Test Date Minute/ss Per Inch / 7
Minimum Recommended Absorption System Size ZOO C% ((51X/S X/G/DMPP B�[OUI lAiLE7}
Minimum Recommended Tank Size I&K�T,,44Z01V5 %ZU0J��eMP�i�%�'(E/Jr�
Special Conditions of
4W.-5-
Issue:
%NE
Issue: NOTICE
Approved for Issuance By
When properly signed for issuance, this application
becomes your permit. Application valid one year from
date. If an individual sewage disposal permit is issued
for property on which no building permit has been
issued, the individual sewage disposal permit shall
expire 120 days after its issuance if construction has
not been commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
the permit, unless approval is secured from the Health
Officer for such changes.
Date �1 1%
FINAL INSPECTION APPROVAL /Lid/ /t�` Date
(Drawing of System on Back)
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