HomeMy WebLinkAboutpitkin.eh.246734304001 (1973)(2)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.
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PITKIN COUNTY HEALTH DEPARTMENT
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PERMIT NUMBER J C O -5-0/ RECEIPT NUMBER
Owner ,tw_ �p u e
-y da rl�l i _ /".,.1V F_..,, �' Phone
Address �t lr 3 6a /r�, V
Contractor _71'l7y�
Phone
Address
Location of system
Legal description
Date,%+ J`f73
Siganture of owner
Lot Size 1
Percolation test data / //./ minutes per inch
Minimum recommended absorption system size / O X a /1# azty
Minimum recommended tank size /,2 A; A
C/
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
'P
o- / Dstywrn /
as
Date �%� /4 Z:5' Sanitarian
I )tr P,
GJLORADO DEPARTMENT OF Hcl�u
dater Pollution Control Di Sion
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION /FOR SEPTIC TANK SYSTEMS
Applicant (Owner): ie JiCJK ` �/lL�!'� �yHI`) - ��-4a-1A)
Mail Address: 3o� City: SAJ6W17WS 'Phone: 9d-3 i 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, soil profiles in test holes.
(
1. Location of Facility: County r 1 /� City or Town S AJOUJ f794 S S
Legal Description rc M-60 Lot Size:
2. Type of area andel (facility - Number of persons served:
Subdivision V Motel _I1114 Restaurant zzl,Q Trailer Court
Other:--';'Aluh T'Ri✓I' J,
3. Source of domestic water: Public (name): ��i:!/ /`iESfl s�IBp71llIS1t7N
Private: Well _&J� Depth && Other a�&- Depth to first ground water table n//3
4. Is facility within boundaries of City or Sanitation District:
If so name:
5: Distance to nearest sewer system: ♦�� +
Have negotiations been attempted with owne to connect:
If rejected, give reason: -tit, 4.'1_
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours:
7. Name, address and telephone of person who made soil absorption tests:
n I
8. Name, address and telephone of person responsible for design of the system:
9. Est. bid opening date: G_ Est. Completion Date: Est. Project Cost:
Date: /�%.if.� Y3
Signature of Owner