HomeMy WebLinkAboutpitkin.eh.246734304001 (1973)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
t
PERMIT NUMBER -�' 60s RECEIPT NUMBER
Owner Lc
,4 �Phone
Addressnx
Contractor �i/.«..f ,__ 2V -?AA Phone
Address r 7
20
T 1 cocK iu�6' z�
Location of system ��� Lot Size �J
Legal description
Date 11 11-7 /9 ry �_ Siganture of owner
Percolation test data —Z / minutes per inch
Minimum recommended absorption system size
Minimum recommended tank size Z.Z& o✓ a i/
0
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
Date �/ Sanitarian
i
COLORADO DEPARTMENT OF HEA
Fater Pollution Control Di ion
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
LC
All
Mail Address: &X
City: :50r" ASS
Phone: q 23 2---A
7
A. INFORMATION REGARDING
PROJECT
SUBMITTED FOR REVIEW:
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, so(i�l prfofiles in test holes.
1. Location of Facility: County Cj�b((l. City or Town;'ut diS
Legal Description NtTrkcI Lot Size: Af- ag
2. Type of area and facility - Number of persons served:
Subdivision v Motel ,LRestaurant .%i W Trailer Court l �`
Other: _ �—" No/I
3. Source of domestic water: Public (name): s, S I
Private: Well iL Depth d� Other � Depth to first round water table ///
4. Is facility within boundaries of City or Sanitation District: L) -n
If so name: fLI
5: Distance to nearest sewer system:. �� 'Jori.
Have negotiations been attempted with owner to connect:
If rejected, give reason: -t& /�-
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours: 14
7. Name, address and telephone of person who made soil absorption tests:
i
8. Name, address and telephone of person responsible for design of the system:
9• Est. (nbid opening date: _ Est. Completion Date: Est. Project Cost:
Date: Idllf
—�—�' Sig a ure of Owner
:1
•S. 5;6.'V,TURES FOR LOCAL GOVE NIENT OFFICIALS: The undersign""ave reviewed the
proposal for the locatio the above-described septic t system and
RECOMMEND APPROVAL or DISAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL
Signator or' oval Health Department
/—% /_7
Signature for Mayor or City Manager
/--7 /__7
Signature for County Commissioners
Comments:
•�F
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:
3 WP -10 (Rev. 5-70-100)
B-;'IF,TURES FOR LOCAL GOVE kENT OFFICIALS: The undersignedave reviewed tho
proposal for the locationW the above-described septic to ystem and
RECOMMEND APPROVAL or DISAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL'
3 gnaiure flocal 'health Department
Signature for Mayor or City Manager
/-7 /—
signature for County Commissioners
Comments:
.rj
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
0. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
qWP -10 (Rev. 5-70-100)