HomeMy WebLinkAboutpitkin.eh.246734308005 (1997)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.
100 FPC=11111111111 P03
pgp ITKIN FI IFLQ p�ENTAL HEALSII.AEPARlWNT
APPLICATION FMNDMWAt-SEvsrtGri4:n - w. - �Isr- - -- ---- ---
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Phone 470-e20.501WFax 970-920.Uq_Q
Permit N Parcel IDN -
Ponnit For. Naw lmllad stir( -i -
Name of OWNER _
street Address 22
Owmes Mailino Address 4_LYy H' 1�
Bu ' Phnra'
Lepel Deectptlon: LAI bluck
size of lot: _L1 acres Typo of propea9d stwctuM
Total areaArvi g xpare (rq. III:
Yqm n, Comam Yeraon _
Content Maiano Address _
BnLnexs Phone: 4 � 1
...fwMn.T.uR^_LLL9.F4{..1.
,0uhdlvlalon ,
4Z-4SiZe 01 bldq. envelope:
M of dedtooms, offices and similar we roams: _
M
WII 1Prlvate wan ( )Spdep ( )9uwuu 1 y',$ammiurrtamunue (Nemo Of—
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19 Proof of Ade00ala Water Ata shed (.RIGUIPs91 ? ( 1 Ye,• ( I No f A water duality test and well pump lest or appy al letter from cammuniry evelom)
Has this project been approved by Pilton County ? (i.,r6an ( 1 No �Ik
If ACHY Mthe lkxattiahi'niaiGniiuS - .}.F...1`,` µN .
Appiwiton for an indridual aawaga disilo"I system k helve suanaea I hereby rAnty that me eoove Information Is lee and eceurala and that I have prw'idsd true are
euz.ala.neormaM. on loraeaa of ed adeang and eropoaad wall., etxthiuf Mwrvr+ nudrlirpa, property lima. dildm. alopa. waleft". soder• suction or inipeaion linda.
ddreng wear dsta . drmn edea. ildpadm etrha. lakes, w&N, cexaa, streams, toodpans. dry gulches, and ehdatinp septle systema. I acknowledge that any 1411148 or
mcorrpNta mi maaon will OvaddaN to aporAtion and art/ vbceduant palmd. lasuenoa of the Pi nNl Was nor Imply the apprwa I of any other parmd required for coruln.:liah
,linuard to Pitdn County codes. No wrdtnadion May W taehoeaken until as aplxwals xn prefmda rave peen obtained.rausunas the owr all
(mspaaibilidas in case of future
or mademw.y of this ayetern. ll
�N Mo-1�r�ti7 nate 'J I 1 y j
Signature or applicant .... (9(J —L
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_.. -------------------- ._________--.. ..___..
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Parc Rats
Fart
Septic tank capacity: IR � D �I � AFI-�`elren i Ahwrption area: LAX^ IF,r- i-k'n'- LM I CV 11 sq. it. 1
Q �l exp h � ��) taT d OL} c r
a0C 0,6w, , Who`" OAPOL r�) Loe vat " CO-1-lil av �p �al9u� s
�m c{oSc StKtz & v0a— x�toL� Wot�v�:. i�l¢c�e �e,
�t.,kk Fix -✓S µ Leh Q<� Yee- 39t� j� or
Cho �- ►� a,s tit
l Icv,tts i'cdL vx, I w 1� re -�D U& b
r}�oppr a� 0 5 wn�tS. 9R1
n lnep6ati la rpalretl r m ft
I of any gun nes11 go 1M distribution rya�rom- m Q_k' Q�
Design by F_rtgineeir Required ? ( ) Yas ( -YQd All plans and spetillcatictis of the engineer must be followed. Any charges must be approved by the
AapenlPllkln Envirorlmntal Health Department iU willing and the M (neer must ccdty in final installation to the Environmental Health Deeanmanl in
writing. Date 1!J
Permk approval by:
Plans and speefitadlxa of Ire ProWaedahavrdual W Poet/ 6ywom rare Dean rw.mw end are OwBA09MI BBI a1 p Y. Pamxau.+n ie r -Inr grstled to tho "Mm"
" o.
m ages W perlom are work,,X klaed in eu"IOMro°'Mln an Nlun dourxy Isbs Regawlm in Base el ma lime of ieaue. This oarma became IMAM a madhe halo tr+ dela
that era pert vies issued oras ayahm canebucuon Ns oommenced a an aaMnsion has been aWrwed'm wilting by the Depammert.
Aa -8u111 Iriwl�g0 must be Included WIM this parnts b ora the final epprovH will W Issued.
Installer.
h,\ ata — =Sloe Plan _. Well Permit and _.,,^ Salla Teat
D
`\vr ete 6U yreceivedFbor pian Water Quality Test or _Date into Complete
Received by Comm Dev Approval _. Water System Latter Final Insp RBgeasted
] Final Inapac8on Approval:ox
__ 4Lf Date /0- 3 �L aPaao,axr