HomeMy WebLinkAboutpitkin.eh.246511400002 (1974)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.
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721,2,, { PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER RECEIPT NUMBER / 7
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Owner 1- c=FZ� �RICG=� Phone N rZ % - 33 !�
Owner's Mailing Address t
Contractor l LX9 -r-,I' Lk)hXf o- (—Ac, kA 0 NLZIil1lPhone N 22-7 - '3202
Address
Systems Contractor's Name
Address
Legal Description b c
Lot Size -D R Type of Building by Use f �S c�FhiLi/c1/
Number of Bedrooms f Type of Water/ Supply tli e- �L
Type of Individual Sewage Disposal System_
Type of Soil or Soil Class ifica""tiion Kr ,I /EL AND 6/-,q J
Proximal Location of Bedrock IV0
Proximal Location of Ground Water Table /vii DE7,!720'glAleD '
Owner's Signature (I
PLOT PLAN:
Percolation Test Data
Minimum Recommended Absorption System Size
;Z O
Minim3= R commended Tank Size
Pex6it application valid one year from Date. Application to
after lower portion is completed and signed by the Sanitarian
CONSTRUCITON SITE
Date_Zj/�L� of 19;'
inrh
. RETAIN THIS FORM AT THE
Date 7 7 Sanitarian / /1 -
(Dr wing of system on back)
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DateReque ted 'd2 / Q
Bill To_ZE/TA/E ZW 16JY7-
Inspection Requested
Original Report To Be Sent
Copy Of Report To Be Sent To
Property Owner
Parcel ID Numbe
Legal 1/4,
Lot Block
4!m
Check/Receipt Number
_Cy
b
Building Occupied_ vacant Age Of Building `t- "
Date Septic Tank Last Pumped # Bedrooms
J� G8
DEPARTMENT RD(XADS:
Permit Number 3u'D Year Issued No Records Found
Septic Tank Capacity IZa (Gallons) Septic Tank Material" - " L¢�L
Leach Field Size qLjl (Sq. Ft.) Leach Field Type
Date Of Inspection Inspector
Soil Conditions: Dry Saturated Snow Covered Other
Septic System: Functioning Satisfactorily ✓ Not Functioning
Comments: YV,).VJyr✓ a r_d u b+ Vu
4,)
Water Supply: Public: Name
Private: Well , Spring , Cistern , Surface ,
Other
Well Construction And Location: Approved C
Unapproved Because
Bacteriological Water Test: Lab Number Date
Acceptable
Other
A.P.E.H.D.:4/87
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