HomeMy WebLinkAboutpitkin.eh.264320407003 (1977)612-003
PITKIN COUNTY HEALTH DEPARTMENT 2 t�
PERMIT NUMBER '7_7 RECEIPT NUMBER
Owner 6 6-e(roN 0"-2 <-) Phone No. 3 - yC,
Owner's Mailing Address 0 (6 J4t'� C
Contractor 6_t 1 7f,n Phone No. [ -� 7 V 0
Address Aon 60
System's Contractor's Name
Address %,3 2
Legal Description � � f- d- L ✓JAS✓,r Cr<e ,s- A 6 A
Lot Size �rQ �� �'� Type of Building by Use Ac se G1 -eh c'..
Number of Bedrooms 3 Type of Water Supply %Orn es ri
Owner's Signature Date Z d- % c, `z % 7
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal SystemD ��J �Vl7�/ Se -P-11(2- %Ne
Type of Soil or Soil Classification SO-/ To
Proximal Location of Bedrock l 'wTUwegy S/MZ-t5,-
Proximal Location of Ground Water Table /vel OK -22 / ������iC'�i9��i� .f �N �F�
Percolation Test Date Minutes Per Inch
Minimum Recommended Absorption System Size 9�iO S42
Minimum Recommended Tank Size 2Sy CAZ_Zow-
SSpLecial Conditions of Issue
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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 propertyon 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
U _ the permit, unless approval is secured from the Health
Officer for such changes.
Approved for Issuance By
✓ Date
FINAL INSPECTION APPROVAL e
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