HomeMy WebLinkAboutpitkin.eh.264316400053 (1991)1
Ir REQUEST FOR WATER AND SEPTIC SYSTEM INSPECTION
USE PERMIUT APPLICATION
Date Requested --1' _c- Check/Receipt Number
Bill To yn e e
-n r�ncr �sAL ("rS -
Inspection Requested By–'YCA--
Phone
Original Report To Be Sent To 0'w,n ,i c cy' 4. '
Copy Of Report To Be Sent To )v .z K "
PRS I F'OR 4ATION•
Property Owner
Parcel ID Number
Legal SL, _1/4, X 1/4, Sec. T ' ; S, RAW;
Lot , Block , Filing , Subdivision.
Address 1 -211, c �n—a .(�'Qen
Building OccupiedV2S Vac t Age Of Building_ i r7
Date Septic Tank Last Pumped I # Bedrooms
DEPAMMENT M)CffM, MU Number Year Issued — No Records ound
Septic Tank Capacity (Gallons) Septic Tank Mater -al L f t
Leach Field Size Sq. Ft.) Leach Field Type M0 idAfyQ
Ila ;PHGTION:
Date Of Inspection, Inspector
Soil Conditions: Dr4ionin
Sa rated Snow vered Other
Septic System: Fun tisfactorily Not Functioning
Continents: i/ai� Ia'�Fh i
Water Supply: Public: Name
Private: Well , Spring Ci rn Surface ,
Other --yr
Well Construction And Location: Approved
Unapproved B ause
Bacteriological Water Test: Lab Number Da
Acceptable
Other
A.P.E.H.D.:4/87
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1".M.15 U P1•. 1 1W 4 Uzi
Date Requested ^5 -1 rf -
Bill To A�.t�Lr c :� n �yli
Inspection Requested By
Original Report To Be Sent To ^`, <
Copy Of Report To Be Sent To
Check/Receipt Number
Property Owner
Parcel ID Number'
Legal x; 1/4, � 1/4, Sec. , T_cTS, R_R__�W;
Lot Block , Filing Subdivision.
Address
Building Occupied e�, Vac tAge Of Building I `( T1 '
Date Septic Tank Las Pumped # Bedrooms I
DEPS RDC CMS• (i
Permit Number Year Issued D No Records ound��
Septic Tank Capacit (Gallons) Septic Tank Mater' 1 JP j',
/A i
Leach Field Size Sq. Ft.) Leach Field Type C � I
INSPECTION:
Date Of Inspection L Inspector
Soil Conditions: Dr Sa rated Snow vered Other
,Septic System: Fun Tonin atisfactorily Not Functioning
Conunent s : 11 [C S
Water Supply: Public: Name
Private: Well , Spring , Ci rn
Other l
Well Construction And Location: Approved R L�
Unapproved B ause
Bacteriological Water Test: Lab Nuirber
Acceptable
Other
A.P.E.H.D.:4/87
Date
Surface ,