HomeMy WebLinkAboutpitkin.eh.264127301002 (1977)(2)Document Layout
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Permit
Application
Log Sheet/Notes & Photos
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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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^7 PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 770 /9/2 RECEIPTNUMBER
0wner6�Eb'o6P ST0.AaAHAN Phone No. a71L
Owner's Mailing Address f�' ny
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Contractor)1064L,16E2
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Phone No.
Address
System's Contractor's Name
Address
Legal Description / E'/Vfi VO /LAC I_ /C (./ --)/ I _j(dJ 7 / L 4—'&1& L_1 /
Lot Size 3,K 3I i / QO eLS Type of Building by Use F AwlN.,4 t�.waiutN C
Number of Bedrooms 3 Type of Water Supply — SPRIMIL,
Owner's Signature a. -��.;� 4 • Date '^ . 1 :2 15—) 2
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal System
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Type of Soil or Soil Classification / �,(JAIF 7—Al UN�c a
Proximal Location of Bedrock 'VD'T- DE��I/AJFP O ET,
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Proximal Location of Ground Water Table A/U- DF��M1 NF0 > 3 / /
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Percolation Test Date Z5 Minutes Per Inch
Minimum Recommended Absorption System Size WO nS-V- F% I5 / X YD-'
Minimum Recommended Tank Size
Special Conditions of Issue: NOTICE
p When properly signed for issuance. this application
T' becomes your permit. Application valid one year from
date. If an Intl sewage disposal permit Is issued
aF�/�S�LLE� gE�pl� B�D for property on which no building permit has been
issued, the individual sewage disposal permit shall
n n `, L+s� expire 120 days after its issuance If construction has
2–) Vlsq j it � / �j– A OMO AW� E72G /� not been commenced. Any change In plana or spacl-
f– yV 1 N ficationa after the permit has been Issued invalidates
the permit, unless approval is secured from the Health
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Of�ier forsuch henges.
Approved for Issuance By �G Date u"""03 7
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FINAL INSPECTION APPROVAL ate
(Drawing of System on Back)
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