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04 (47
ASPEN*PITKIN W, 7- 1 y2- O P - Do
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
TYPE OF PERMIT:
T.A 7n ltlal Construction ( )Emergency Use ( )Repair Wark,(Piuvlous Permit 1 .) ( )Alteration of an existing system,
or Installation (Previous Permit 1
( )Use Permit as a result of sale ( )others
ISSUED TO:
DATE OF ISSUE L 1
Owner} Vj�p) ingy��Aome PhoneBusiness Phone
Mail -
Address Iw U, ��`�.5 1 gt6
Agen t_
Mailing
Address
Sewage Disposal System Work to be performed by
This permit valid only for premises location by the following legal dceerlptlons LOT 5-M-63 61KK.W!4 ''O77T W�'NAS�S MOA
Laf SIZE 1.16 A.(`a�, MATER SUPPLY AVERAGE PERCOLATION RATE
This Individual Sewage Disposal permit is granted with regard to the following mo:,�IILy KQQ��%(S&16f1rI
70W.,ber ofs Dodreoms 9— Lofts_ Garbage Disposals_ 1 Dishwashers��ri"t,s W'0'rs �_•
CALCULATi.D AVERAGE DAILY WASTE LOAD ��() GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Typ•r of Tank or Treatment Units CO- +kx1- Tank Capacity Gallon Mlnlmu.•s
method of Final Disposals (�rnp �t-r-�—.)-rQ&c45 Absorptloa )Less mjj5CS= M square Peet Minims .
.Description (including brand name, if any) of other equipment or appurtnancest 16,90 5 owe, 7ez-"
%ef,a eA� yeF.pueeO GeJl9it+ D0,S1N9 A'Vo
l EPG ✓SL -r X27 7 ,L1 A11&ALF& -.6P
s
Other Candltionor Specificationst
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
I )Before Excavation ( )Upon Completion of excavation and prior to p1meement of gravel ( iBefore covering distribution
system of absorption field
ldPrlor to backfill of any component ( )other, specify,
Plans and specifications of the proposed sewage disposal system have G -en reviewed and are considered satisfactory, pecmission
is hereby granted to tl.e, owner or his agent to n�rform the work indicated above in accordance with the Pitkin County Individual
Svwage Disposal Revelations in effect on the date of issue. In addition to general provisions met forth an the reverse hereof,
this Permit is subject to the following additional terms and conditions:
APPROVED FOR ISSUE BY (title)
Thr aG,vc ln.ilvldmi et.ta•No disposal syetcm lnatallCd by _
has b:cn ln.:prcted for use by a represcntattve cf the Aspen 1',t to Cnv, ron.�. eta ilea impar UnCllG. That uvnut' ]ve,LLmf irl
rc::N,ansil,lllly in coat of failure or inadequacy of thin sevaqu dtaposal system. Cae.Plete as -bulli drawing attached.
DATE OF FINAL 1NISPEICTION
BY:
Cc- r. 0 LL, =y �
130 South Galena Street
TI'f1,E
Aspen, Colorado 816'11 30"00-6070
A%7-343-0%-00rj
• ASPEN*PITKIN •
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of
OWNER
�flRE-N
T CIE09CrE
IF-F-)PEll_
PHONE
9c�5 -Ocj[f
Address
of OWNER
��
�' (
l+5 -e,�
co
SIGI
Name of APPLICANT 511n 1C- PHONE SF}M C—
PERMfT TO BE, ( )Picked Up - ( )Mailed to: TYPE OF PERMIT: (,4 Kew Installation ( )Repair
(()Owner ( )Applicant ( )Emergency use ( )Alteration NOT due to failure
LOCATION Or PDOPOSED SYSTEM:
Legal Description
Sot Block Filing Subdivision Gi TEN.S`f Size of Lot acres
TYPE OF STRUCTURE: (K)Single Family Dwelling ( )
No. of bedrooms 0 - No. of Le Re
No. of Automatic Clothes Basher
NATER SUPPLYr ( )Private Well, Depth_
( )Spring
( )Stream or Creek
Co you plan any further additions to the
residence? ( )YES ( )NO
No. of Garbage Disposals I No. of Automatic Dishwashers
or (iPublic, Name of System CTSO') Home_ 0W/Ie✓5 as�_I
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED,
(il Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
(IRecycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other,
The initial site inspection must be arranged with the Aspen/Pitkin Envirorustntal Health Department (925-2020, 9:10-9:30 a.m.)
before a permit can be issued. The individual sewage disposal permit must be issued before a building permit can be obtained.
FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
Is true and that falac info r will i/aaaAiidd�aattee tt)he application and any subsequentt L•. p'
Signature of Applicant s ;311 2 L%b-/'J ✓ DATE Cl M✓ U
j (This application becomes. invalid,12 months from the above date.)
NOTE: PLOT PLAN must be filed with this application.
Please locate the following items by measured distances:
1. Property lines and dimensions.
2. Proposed and existing water wells on subject property and
adjacent property. _
3. Domestic water service lines.
4. Proposed and existing buildings, driveways, and other
structures.
S. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existing individual sewage systems on subject
property. _
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
The undersigned h�(�,ereOY acknowledges receipt of this individual sewage disposal permit application and a permit fee in the amount
of f �Oy Receipt Number Date Fee Received �bY /-'-)X
Administrative ofllccr
rr�C'�aly3
�� 130 South Galena Street Aspen, Colorado 81611 303/920-5070
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