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Please See Building and Land Use Approvals Files for additional information.
OCT — 1 4-92
W E D
10,62 0-TA C K W ILK I E B L - D R
- 'ASPEN*PITK(N
ENVIRONMENTAL HEALTH QEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL, PERMIT
P. 02
Name of
OWNER
PHONE 4/L--
Address
of OWNER Q it 416 onuEe
ST2oes
• Fil
�S6$D
Name of
APPLICANT !Vk- WIcklF&urcDt
ING.
PHONE qZ} qLZ�
Twtt TD 0 Sid Picked Up • t )nalled tot T"t of pr"I A t )Hew 24stallatl41% ( Impair
f fOwner ( )Applicant. 4 )Ewergd" Dae fAluration HOT dueoto fail,;,
AeRTtdl Or Phoposro sTsT ,
Stgal ascription 0909' . WkrfG SM.ta o.Pr✓r,a ia,'+PLN _ _ _ _
.at Y7 Slott Tiling^� subdivision WNrrAr511 IQ/ 6k5sise of Lot T-
or tmarcTDed t lilmgle ;,veil; Dwlling (+OOchers f_W VWY _V1Jrr . to yoe Dian any turtber seditious to the
&aslde16ce1 , 1 )tui I IHC -----• to. of badrooHs Mo. of Tofte Ho. dt Carbaga Disposals 9b: CC aatosmtic Dishwashers
$a. of Aatanatle Clothes Hashers _
esu sU 1private Hail. tap" or ( !Public, nut of system
( )Spring
• f Istrou or Creek
lTPIS Or INDlyi DOAL SmArt DISPOSAL SYSTem PROPOSED$
$4septie TsnVAbsorptlos rield ( 13aratlas flame Absorption rield ( I0ompostin1,Toii4t 1 )!aclnerattoa Soilat 1 )Hound
( IPoerCllag, potable Use ( )Recycling, other Use 4 Ivaulc Privy 1 lOther6
The'lsitlal site inspection swat be arranged with the Aspon/pltkln•tnvlreamantal Hcalch Department 9923-2020, 4630-1130 a.m.)
Ware a permit can be Issued. The lnalvidusl swage dlapoaal pewit must be lasucd before • building pormit can be obtained.
,...w AAe p}leaNM'✓+'r Cttji 'loom "<� .. __ ..
►IHM1L INSP[CTSOH APPROIrAL 11VSY PC CIVGi sY TML ASPOe/PI'[RIH tNVIRONMtnTAL �HEALTH•Ov'ARTMtH7 PRIOR SO aACKI•ILL2H0 ANY POA21at1
or enc srsTm.
"11cation for an Individual swage disposal permit is honby submitted. The undersigned acknowledges that the ,bow Information
to trw and that false Information wit validate the application and any subsoqueat raft
�)
signature of Applicant a ��✓ra'D DATt IOp 1 RZ
(This application becomes. invalid 12 wontba from the above date.!
NOTE: PLOT PLAN must be £sled 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
strubtures.
S. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existing individual sewage systems an subject
property.
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.'
Sha undersigned hereby acknowledges receipt e! this 1)Wlviduel swage disposal parm t •p lleation and a por4y_fe� in the amour
of 4 fsQ, - _ , Receipt Hus1berCi-,tZ I �l Date Oce Received 10 A 1 y06.by
Adminlstrstiw officer
J
130 South Calene Strect • Aap6n. Colorodo 81611 309/980-6070
' f • ASPEN*PITKIN 1 3' 53-01- oq3
ENVIRONMENTAL HEALTH OEPAR ENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT 140.
TYPE OF PERMIT:
( )Initial Construction ( )Emergoney uss ( )Repair work,(Pievious Permit 1 .) X)Alteration of an existing sistem,
or Installation '\(Previous Permit i ,)
( )use Permit as a result of sale ( )Others
ISSUED TO: DATE OF ISSUE.
Owner �a. I f�%/��Cl� l -fi i I Home Phone Business Phone
Mailing `_ t
AddresslPAcT l (J%�I7v �rA� ��Nefii=s eCfeOQ iA)n14P S 44P—
Agent Phone
Mail;ng
Address
Sewage Disposal System Work to be performed by
This permit valid only for premises )*cation by the following legal doscriptiont
LOT 511E I MATER SUPPLY AVERAGE PERCOLATION MTF.
This Individual sewage Disposal Pcrmlt is granted with regard to the following
Mu..bor of Dodreoms Lof is Garbage Disposals Dishwashers Clothes Washors _
CALCULATfA AVERAGE DAILY WASTE LOAD GALLONS.
THE NATURE OF THE SYSTTEE:�SflINCLUDED UNDER THIS PERMIT:
Typo of Tank or Treatment units ate• ' '�'`' ' ' Tank Ca ashy (�• Callon MInlmum
Method of final Disposals/tiles-'�� "��jE�T� Absorptioa Area 'X)31 jA/G Square Fact Minimum
escriptlon (including brand name, if any) of other equipment or appurtnanceas
Other Conditions or Speetfieationss
Effie- 1AAt1K D,J.&Y
(FOR /QECENTL-Y Al'ole VIf0 Cf1i ,--7,- if%! T).
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
1 )Before Excavation ( )Upon completion of excavation and prior to plscenent of gravel ( )Before covering distribution
system of absorption field
( )Prior to backfill of any component ( lOther, Speaifys
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
is hereby granted to the owner or his agent to perform the work indicated above in accordance with the Pitkin County Individual
Scwage Disposal Roaulations in etfvct on the date of issue. In addition to general provisions act forth on the reverse hereof,
this Permit in sul•iect to the followingadad%ditional terns and connd/i/JtLonss
APPROVED FOR ISSUE BY q&7~ /-, / (title)
Thr above indtviduai acwago disposal system installed by / r$RF4 a—r•/�TH/140111 t/9
has been Ln:ipectod for use by a rcprrsentattvc of the Aspen 11tt in Cnviro.
nm•nta 11calth ne.pam
rtcnc. TFL ,,nor nsaumen a
reo,wnsib111Ly in case of failure or inadequacy of this evaga tspoaal system. Complete as-buLlt druving attached.
DATE OF FI INSPECTION �D Z—
BY: Or TITLE
130 lybuth Galena Street - Aspin, Colormcib 61611 303/GRO-6070
,rrcaepeon
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