HomeMy WebLinkAboutpitkin.eh.246734304003 (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.
PITKIN COUNTY HEALTH DEPARTMENT
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,((,�� PERMIT NUMBER �rC LI RECEIPT NUMBER
Owner { 4 �� ,,.�� Phone
Address .Tn . gp�
Contractor Phone
Address
Location of system H LOT 3 ej4&e/
Locatio
y 3� �� /UN( 2 --Lot Size /
Legal description
Date 44&-Z-9
. -;;P' q Siganture of owner
Percolation test data / �y /s/ ' minutes per inch
Minimum recommended absorption system size
:Minimum recommended tank size />< �q
Permit application valid one year from date. Application to become permit and
final only after lower portion is completed and signed. Retain this form at
the construction site.
DRAWING OF SYSTEM
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Date �Fsc�� y3 Sanitarian _
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QARADO DEPARTMENT OF HEA&
Weter Pollution Control Di ion
4210 East 11th Avenue
Denver, Colorado 80220
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APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner): Z4.61 p/.q. 74 - 6;w�LYAJ
Mail Address: 3C— City: Phone:
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: %a3 7 7
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable water wells,
soil percolation test holes, soil pyofiles in test holes.
1. Location of Facility: County City or Town
Legal Description ^� Lot Size: o a-GAZQ —
2. Type of area and facility - Number of persons served:
Subdivision L,-'� Motel �� Restaurant _Trailer Court
Other:
3. Source of domestic water: Public (name):
Private: Well &U Depth .4La_ Other JZL Depth to firit ground water table A/,q,
4. Is facility within boundaries of City or Sanitation District:
If so name: 4/4.
S: Distance to nearest sewer system:
Have negotiations been attempted with owner to connect:
If rejected, give reason:
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours: I ",;,,, 1 y 414,,.%
7. Name,
(L/(address a(nd telephone of person who made soil absorption tests:
8. Name, address and telephone of person responsible for design of the system:
9. Est. bid _opening date: _ Est. Completion Date: Est. Pro ct Cost:
)ate: /'/ L �3 /173
Signature of Owner
B."52GNF.TURE•S FOR LOCAL GOV&ENT OFFICIALS: The undersign ave reviewed the
''proposal for the location of the above-described septic tank system and
RECOMMEND APPROVAL or DISAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL
ign�or'Loca health Department
/-% /-7
Signature for Mayor or City Manager
Signature for County Commissioners
Coromen is
Signature and Title
Note: The applicant must obtain the comments and signature of at least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
IWP -10 (Rev. 5-70-100) A
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