HomeMy WebLinkAboutpitkin.eh.264305300004 (1979)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
PERMIT NUMBER - -Ac s RECEIPT NUMBER 2971-5-
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Owner MbM I � �IZL tVD �.yYt N N( -kA Phone No. elio r6
Owner's Mailing Address 'O• iayl� 1-,�->-K R,-�pEa' , oo • k I l, it
Contractor )A1 Afz t U` EI -V! .I Phone No.
Address
System's Contractor's Name
Address
D,206 4o-Al4,,
Z 2Af_r 1r- L 011 5, T04
Legal Description I S 4W* Lill b Pi
Lot Size
Number of Bedrooms
PLOT PLAN: AYTACHED AS REQUIRED
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Type of Building by Use 11 -+— ion NT'f ts--`
Type of Water Supply Lt -1 V ---
Date
Date �,29
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Type of Individual Sewage Disposal System 2i'T/C /ANIS -->EC7fA!GE "'-
Type of Soil or Soil Classification //Oil LOAM TO SA/W)i CRAWL APA2 COOPtES'
Proximal Location of Bedrock /VO'T DETEt'M/A/ED - 6XI60re2e TN.441 It FT
Proximal Location of Ground Water Table
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Percolation Test Date / / J y Minutes Per Inch
Minimum Recommended Absorption System Size
LaGU
Minimum Recommended Tank Size
Special Conditions of Issue: NOTICE
When properly signetl for issuance, this application
become your permit. Application 'alitl one year from den. It an individual sewage disposal permit I+ issued
for property on which no building Permit has been
issued, the individual sswage disposal permit +hall
expire 120 days attar Its issuance If construction has
not been commenced. Any change in plena or specl-
fications after the permit hes been Issued invalidates
the permit, unless approve[ is secured from the Hwlth
Officer for
�such
chhange,,
Approved for Issuance By Date
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FINAL INSPECTION APPROVAL Date
i(Drawing of System on Back)
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER IAC" -PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
TEST HOLE No.1
TEST HOLE No. 2 TEST HOLE No. 3
Drop3 L I Time
Drop Time Drop Time
3 o
2 6 I -So
1
/ O
1
Percolation Rate Each Hole
Average Rate 4
7 _
Comments n or site -
y
Signature
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