HomeMy WebLinkAboutpitkin.eh.246720101001 (1976)Document Layout
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Permit
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Engineer Design
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Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
76079
PERMIT NUMBER
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PITKIN COUNTY HEALTH DEPARTMENT /
RECEIPT NUMBER
Owner / — Phone No.
Owner's Mailing Address✓ C5T/�"�/" � e E l�� z>
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Contractor /1 j` �x �—� �`' d�'— Phone No.
Address y�� 6,—;0e Al'J
System's Contractor's Name
Address /) /,I-<
Legal Description
Lot Size 'ey /."�-'TYpe of Building by Use
Number of Bedro ms Type of Water Supply «�� e LL --
Owner's -71
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Owner's Signature �l/ Z 2�tt Date — 4
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Dispos
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Ground Water Table �lI pFTEeml NED -:--> / 7 /
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Percolation Test Date QrIGH7ED AVCS,
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size &00 ALL0A)9 —Z2V6 dORPIfe MENT-S
Special Conditions of Issue: NOTICE
p 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 shell
expire 120 days after Its issuance if construction hes
not been commenced. Any change in plans or speci-
fications after the permit hes been issued invalidates
the permit, unless approval is secured from the Health
Officer for suc chang
Approved for Issuance By Date —�
FINAL INSPECTION APPROVAL ate
(Drawing of System on Back)
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