HomeMy WebLinkAboutpitkin.eh.246720100003 (1976)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.
PITKIN COUNTY HEALTH DEPARTMENT
76066
PERMIT NUMBER
11
Owner 22
Owner's Mailing Address l
Contractor 6 ^G A r
Address
System's Contractor's Name A/\ 0
Address
Legal Description
RECEIPT NUMBER /
Phone No.
No.
Lot Size J/) 4A " - Type of Building by Use
Number of Bedrooms Type of Water Supply
Owner's Signature Date
3 _ 7
PLOT PLAN: ATTACHED AS REQUIRED
!*************iN****!##*N*******i********N*****#*N*******#*****N**!*********#************i
1v —
Type of Individual Sewage Disposal
Type of Soil or Soil Classification
Proximal Location of Bedrock / rr �� �MINF� V ��EF 771AA 9 /Z7E7-
Proximal Location of Ground Water Table �� D�/CSM/Nfn—�'Ef' %t/An/ W FEC� )
A#*##iii N!#i!#NN#!N!####i*####ii##N####a a a is #Nia*!!i!###YN####ilii NN#/N'#/Ni!#ii*N*#NiiiNii!
Percolation Test Date — S Minutes Per Inch �? 7 176
Minimum Recommended Absorption System Size ,/ / -'; f ,
Minimum Recommended Tank Size ZOO ��I LOI S � � t b ` /1
61Vj0Ar2VEA/"`TS
Special Conditions of Issue: Nonce
p When properly signed for issuance, this applieatlOn
becomes your permit. Application valid one year from
data- If en 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 s ch changes.
Approved for Issuance By //� `e4� �' Dates
iif#ii*##
FINAL INSPECTION APPROVAL Date
(Drawing of System on Back)
I
OFFICE t�N�Du�A�F
Po2CH
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YARD
PA�KIN� '
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o GALLON
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER /� �� �LL �P/C PHONE �2--311311
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
TEST HOLEN9.1 TEST KOLE•
i1MMMM�rc��'i
&/l.-�A=•LV•U
Percolation Rate Each Hole
Average Rate
Comments on sail or site:
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Date
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