HomeMy WebLinkAboutpitkin.eh.264904401003 (1980)_VOID, NOT BUILTr PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 76030 RECEIPT NUMBER
Owner o °z a ���� Phone No.
Owner's Mailing Address X , C 4/e h o h
Contractor
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/ . iJ� Z �� fp� Phone No.
Address
Z
O h
System's Contractor's Name
Address G a 1Z
Lege! Description o �� X�
Lot Size �� �' ra Type of Building by Use a
�%6V;v,,S ! Ove
Number of Bedrooms T pe of Water Supply
Owner's Signature Date U
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock
N
Proximal Location of Ground Water Table
Percolation Test Date Minutes Per Inch
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
Special Conditions ssue:
V
Approved for Issuance By
FINAL INSPECTION APPROVAL
(Drawing of System on Back)
NOTICE
When properly signed for issuance, this application
!/
becomes your permit. Application valid one year from
date. If an individual sewage disposal permit Is issued
for property on which no building permit has been
issued, the individual sewage disposal permit shall
expire 120 days after its Issuance if construction has
not been commenced. Any change in plans or speci-
fications after the permit has bean issued invalidates
the permit, unless approval Is secured from the Health
Officer for such changes.
Date
Date