Loading...
HomeMy WebLinkAboutpitkin.eh.264522400015 (1979)SEP, 13. 2010 10:49AM ENVIRO HFALTH NAT RESOURCE ,26 � 7N0. 4981— cP, 1 D/�_ System's O lla or's Name E Legal Description Lot Size'� • - Type of Building by U -se Number of Bedrooms Type of Water Supply C� Owner's Signature Date ' PLOT PLAN: ATTACHED AS REQUIRED �F jE Sb •K• •14 •k # -k• i• # •3F � j6 aF •k aF 9S• •iE * # � # '1[• i,� lF +1h aF •1P •)(• # •)E' •)F � •k jE •it• •iE � •fF •k• � 9F 9f• * •�• •# # •3F # •1F at 9V JF # 'm •lE iF -x• •x• # 9E 9E at• aE d!• 11h •k• d0 w w # •k # dE 9(- # � 3E # -lE 9F # iF # df• ati 8n }} �} •� Type of Individual Sewage Disposal S stem ! la Y /.. Type of Soil or Soil Classification ,• Z(e9AIY P r�xlmi3l Location of Bedrock Proximal Location of Ground Water Table 1 6Z t Percolation Test Date 7 /7- Minutes Per Inch Minimum Recommended Absorption System Size Vi ng % Mins arum Recommended Tani: Size 444, Special Conditions of Issue: NOTICE When properly signed for issuance, -this app'Iitation becomm your permit, Application valid one year frog, date. If an Indlvidu*l sdwagc disposal permit Is Issued for property on whiph r10 building permit has been issue¢• the individual wwege disposal permi-t shall expire T20 days after its issuance If conmuation ha: not been commenced. Any change in plans or opeci- ficatiQns after the permit has been issued invaiidatds ,rho Permit, unloss approval is secured from the Health Officer for Such change;, L,&�, Approved for Issuance By ata '�+ '� # # •#• •R- •Yi ,Y• `K• bG 4F 'k •� # •�' �• .g •{• •� # i• •� � •Y• •Y• � � � .Y. � �• ,1'• 4p �' 'R 9F '�• •�' � •A• � # & •� •�' •� & •I• �C• # •DF # •�' # •�• '3f• �' '#• # •$' �e .Y, '� 'R• •& .A4 �' � '� •� •�• 'jy .h. Y• �• iF •Y # # 3r # # # •I- �• •� CFINAL INSPECTION APPROVAL Cate (Drawing of System on Back) afoL/S- 0 — OSS' PITKIN COUNTY HEALTH DEPARTMENT F PERMIT NUMBER ( �(-� L� RECEIPT NUMBER f Owner !v �m� '� Phone No. Owner's Mailing Address r,4;-7? (;3CK Contractor 0 ��'��Phone No. 26� s Address �� �� 6V, System's CPTJor's Name Address -49. t�cc__)Ali6 Legal Description zlci If c S41 (/-y 0 7i4<�ci � 1j Lot Size v? ' 3 4cXe-5 Type of Building by Use Number of BedroomsType of Water Supply 4-,>6L<-- Owner's Signature Date __7 PLOT PLAN: ATTACHED AS REQUIRED System Individual Sewage Disposal S Type of d g p Y Type of Soil or Soil Classification CLAY L©AA1 7d t)Afq 7Z SILTY �/41/��-- YP . P tion of Bedrock 4 �XX7F 7�K,t U Proximal ma I Loca ,, / ?" Proximal Location of Ground Water Table ���Z] f 7W141L Percolation Test Date .� *30 Minutes Per Inch Minimum Recommended Absorption System Size 0 a, Minimum Recommended Tank Size /2�D CAZ,6eNS Special Conditions of Issue: 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 been issued invalidates the permit, unless approval is secured from the Health Officer for such changes. Approved for Issuance By ate FINAL INSPECTION APPROVAL _ Date ( Drawing of System on Back) I r�r -2"57 4,9 ;Ee 1