HomeMy WebLinkAboutpitkin.eh.246334102038 (1977)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
Communications
As -built Design
Engineer Design
Soil Information
Water Permit & Information
Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
jPITKIN COUNTY HEALTH DEPARTMENT
7PERMITNUMBER 'f 7m14 RECEIPT NUMBER �} �1 rt �1 Phone No. 3 -
Owner
Owner's Mailing Address �� ���� ��f) tom' %a (Zi �A 1)4 k, r ,, (',--
Contractor L JA I� f_t�t'��� t y '7 7� Phone No. �F 4 3 3
Address -�I )�.—x lJ o c) C
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System's Contractor's Name
e Address —(A
it LSA U U
Legal Description A / 2 cJ�LtJrLL SL��
Lot Size Type of Building by Use Ji )t�/w
Number of Bedrooms�O Q ^ Type of Water Supply C.p R : >t J%J9 �` ort
Owner's Signature ` Date ? 7 7
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Ground Water Table
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Percolation Test Date
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
1 Minutes Per Inch 3
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Special Conditions of t�sue: NOTICE
When properly signed for issuance, this application
�s-s�r 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 "wage disposal permit shall
expire 120 days after its issuance If construction has
1 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.
Approved for Issuance By / Date ng
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FINAL INSPECTION APPROVAL aaRaaaaaa Raaaaa a aRaR BiB NR RM NN YNaT as NNNRR Yaaa as RRNNra Raa
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FINAL
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PROPERTY OWNER
MAILING ADDRESS
LEGAL
PITKIN COUNTY ENVIRONMi=NTAL HEALTH
,Field Testi Data Sheet on Percolation Test
PHONE 9Z3"2.3��
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
36 y 3S"
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
,I
Drop Time
II
Drop Time Drop
Time
3`
" �/
617
3 3
G
D`
Percolation Rate Each Hole
Average Rate
Comments ons
oilor site:
P,
Signature
3
Date 1-2—,��I-
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