HomeMy WebLinkAboutpitkin.eh.246734305005 (1980)Document Layout
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Permit
Application
Log Sheet/Notes & Photos
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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.
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PITKIN COUNTY HEALTH DEPARTMENT Q
PERMIT NUMBER 80002 RECEIPT NUMBER 33a' 77
Owner i�— tf*eastoEi—Wn= Phone No. 2ZS-Ps"(a wrr l7.5- s4
Owner's Mailing Address
Contractor L1= Phone No.
Address
System's Contractor's Name f=-�s
Address
Legal Description Lj:ff :3 F-k:r--� :L2> FI L(nia rZ.
Lot Size Type of Building by Use X16 + GUCST N0dSCj?r J
Number of Bedrooms 2r';Type of Water Supply �r
Owner's Signature ZDate- �• �%
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal
Type of Soil or Soil Classification
Proximal Location of Bedrock A10- DE , CeM/A1E1� [�.C�%2ie %/IIAA) p
Proximal Location of Ground Water Table Ivor
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Percolation Test Date
Minimum Recommended Absorption
Minimum Recommended Tank Size
Special Conditions of Issue:
Size
7-EM�inutes Per Inch
533 M 4-ek
NOTICE
When properly signed for Issuance, this application
becemas 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 shall
expire 170 days after Its )nuance If construction has
not been commenced. Any change in plans or apecl-
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 YL u ` Ca44'`4�. -Date -el —.2 9/ PC/
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14PAAL IN$PE /TION PPR VAL Date —/,J�
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