HomeMy WebLinkAboutpitkin.eh.264504303004 (1978)PERMIT NUMBER
Owner
Owner's Mailing Address
76039
� 2- &,V/ -04`,� -- �3 - �L
PITKIN COUNTY HEALTH DEPARTMENT
RECEIPT NUMBER
Phone No.
Contractor
W ki E 1 Phone No. S
6-5-14
Address
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System's Contractor's Name
�d �B
Address
Legal Description
Lot Size � •
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Type of Building by Use
Number of Bedrooms
Type of Water Supply
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Owner's Signature
Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System��/1 �=' ���`^ ���'��✓� �L "/y�
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Ground Water Table �'
11 %
A ,l
.� Minutes Per In h �C 7
Percolation Test Date _
/5 .E ��
Minimum Recommended Absorption System Size`
Minimum Recommended Tank Size
NOTICE
Special Conditions of Issue: when properly signed for issuance, this application
/
/ l /_..t� �/ h -i ► ) becomes your permit. Application valid one year from
7V,AVA date. If an individual sewage disposal permit is issued
' Lj for property on which no building permit has been
�G<7issued, 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 su h changes.
Approved for Issuance By r Date
FINAL INSPECTION APPROVAL
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