HomeMy WebLinkAboutpitkin.eh.264316300043 (1975)Q
PERMIT NUMBER 7 2 0 034
Owner
PITKIN COUNTY HEALTH DEPARTMENT
RECEIPT NUMBER
Phone # VZ -3 - ,v%?O
Owner's Mailing Address / r,0, eol 1ZL6- fI5'151�-141 R/,�, //
Contractor T/vsTr4,lld �� owtiE,e. Phone #
Address
Systems Contractor's Name
Address
Legal Description q /n/ ,Co r %3 O•�/G - y - 85
Lot Size Type of Building by Use5-7"6/,O7/O �Ov�j�',GD��
Number of Bedrooms Type of Water Supply I)O A) 15
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Groun Water Table
Owner's Signature
-FiOT-PiAN:�"yPE o si�-.� CoM BusTio.v trivii�
Sh�c,ET' --4/67
E
I al
Percolation Test Data my Minutes per inch
Minimum Recommended Absorption System Size �1✓ !�'
Minimum Recommended Tank Size ✓
Permit application valid one year from Date. Application to become permit and final only
after lower portion is completed and signed by the Sanitarian. RETAIN -PIIS FORM AT THE
CONSTRUCITON�SITE.
Date i1 Sanitarian ; t,, D , `
(Drawing of system -On back