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Please See Building and Land Use Approvals Files for additional information.
• ASPEN*PITKIN
11-16 ? - 16 2-01- 00/
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
OF PERMIT:
`T`YY,PE
(1�lnitial Construction
( )Emergency Use
1 )Repair Work,(Pievious Permit 1
.) ( )Alteration of an existing system,
r installation
(Pre vlow Pc rmic / .)
( )Use Permit as a result of Sale
( 10thort
ISSUED TO:
DATE
OF ISSUE.
Owner�TpHdt44O t)CgeHOELtElL
Home Phone925--6950
r,
Business Phone �S S,53/
Nailing
BLeel(�
c
Asffi700
Address 615
UT
8161/
Agent NPhone
Mailing
Address
Sewage Disposal System Work to be performed by L))J"bU)d
Th!s permit ��aa/lld/�/o�nlly for premises location by the following legal
/,1Id''eserlptlonr�,OTA5 NOLLJ4/Jo ��f_,.s../t/OUI fat)
LOT SIZE 3�'-f AUe WATER SUPPLY SdWjVjSj&JWE(1S , AVERAGE PERCOLATIOY RATEE%%�7
This Individual Sewage Disposal Permit is granted with regard to the following usot SAj&f.E /-qH//y /(C$IDEM-e 'Mit
Itm..bcr oft Dodreoms 3 Lofts_ Garbage Disposals Dishwashers_ Cloches Washers
CALCULATED AVERAGE DAILY WASTE LOAD GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
}ya of Tank or Treatment UnLt{eEpr/ 1 A4r— C /� Tank Capacity _Gallon minimu:s
r� thod of Final Disposal, SEEPAC,E �TEn/C NES Absorptloe Area e. Square Fe.t Min Lmum
Description (including/brand name, if any) of other equipment or appu[tnanecas cC��
c USe
FL -WATER CLOSETS
Ct!.cr Conditions or Specifications,
/VAA O
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: I'
( )Before Ex.avation { Upon oocpletlon of excavation and prior to placement of gravel (N Before covering distribution
///��\ system of absorption field
KP
to backfill of any component 1 )Other, Specify, 110jue __-
plans and specifications of the proposed sewage disposal syntem have born reviewed and are considered satisfactory. Perm L•tal.on
[n here'" graded to chi owner or his agent to per(nrm the work indicated ahnve in accerJance with the Pitkin Count Individual
Shia ;e Disposal subject
tons in following
on the date of Segue. In addition [ yanc[el provisions set forth on Uro reverse hereat,
this Permit is mhjoct to C:c following adds tional Cecma and conJi ons: j%eA/s, '
t
APPROVED FOR ISSUE BY -:4 (title)
The alive individual sewago disposal system Installed by
has torn lnnpoeted Lor use by a rcprrecntattve cf the As
raalwnsibllity in case of failure or Lnad quacy of thty/
DATE
I of'S
130
sin Lnvtronn+rntai uea,,.n ucparuscnc, ins oWnar annum
diopoul system. Complete as -bull[ drawing attached.
• ASPEN*PITKIN •
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWNER C �i � + Sv /i �C � � )z �L.i PHONE lh_ ]S_ / 5 /
Address of OWNER
Lr
NCu
Name of APPLICANT -yet -if) PHONE A 5J_V
�� of l -t 1 i (,Cj S O
PERMIT TO BE: ('.)Picked Up ( )Mailed to, TYPE OF PERMIT: (19 Nev Installation ( )Repair
(IfOwner (7 ApPlleant f )Emergency use ( )Alteration NOT due to faLluie
LOCATION OF PROPOSED SYSTEM, /
Legal Des//cr//i/pt;on L c,\ L4 L)Z_(
Lot T "� Block Filing
TYPE OF STRUCTURE: (y)Single Family Dwelling ( )Other[
Subdivision _ t1_1 Sire of Lot _7 /� acres
Do you plan any further additions to the
residence? ( )YES E-1NO
We. of bedrooms :ti - No. of Lofts 1. No. of Garbage Disposals No. of Automatic Dishwashers
NO. of AYtonatlt Clothes Hashes �
NATER SUPPLY: ( )Private Well, Depth or (.1Public, Name of System 1-1[) D
( )Spring
1 )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED,
(.ISeptle Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
( IRecycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other:
The Initial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department (925-2020, 9:30-9:30 a.m.)
hfore a permit can be issued. The individual sewage disposal permit must be Issued before a building permit can be obtained.
FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPZ1:/FITKIN ENVIRON:)ENTA:. HEtdTH DEPART.ENT PRIOR TO BACKFILLING ANY PORTION
OF INE 5YSTEM.
Application for an Individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above Information
is true and that false Inform n will invn lid to the ap lleation and any subsequent permit.
Signature of Applicant t DATE %, / (,
(This application becomes. invalid 12 months from the above date.)
NOTE: PL T PLAN must be filed with this application.
Please locate the following items by measured distances:
1. Property lines and dimensions.
2. Proposed and existing water wells on subject property and
adjacent property.
3. Domestic water service lines.
{. Proposed and existing buildings, driveways, and other
. structures.
S. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existing individual sewage systems on subject
property.
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
She n ereby acknowledges receipt o this individual sewage disposal permit application and a per. tt fe in the amount
of
IunderaI d hReceipt Number ,5s'3 /9L , Date Fee Received —,r.2� 0 ,.byAdminl Administrative OC[l car
am -4 61778 _
130 South Galena Street Aspen, Colorado 81611
303/625-2020
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