HomeMy WebLinkAboutpitkin.eh.264321100004 (1976)0 1;�(Ay?-.2 1J 00 004/
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 76061 RECEIPT NUMBER -2
Owner Za 6lLf? % L, !�'� Phone No. t:2
Owner's
Owner's Mailing Addresses
Contractor Phone No.
Address
System's Contractor's Name
Address@
Legal Description ®T SA=C 2 -7 ra,,5,*iu+ 1 so, +oa(g_ SrS k1 4r,T" /0
Lot Size Type of Building by Use
Number of Bedrooms Type of Water Supply PR
Owner's Signatu Date ZT&
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification t "` ,q 'Fz
Proximal Location of Bedrock z _jLL D�E /V/A Q l
Proximal Location of Ground Water Table IVC7- D 6;27-�M Z IV EL > F5
Percolation Test Date Minutes Per Inch
Minimum Recommended Absorption System Size Z„_3� ax' F,7—
Minimum
TMinimum Recommended Tank Size A000 ('271_461V ) — 72�)e
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 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
the permit, unless approval is secured from the Health
Officer for7h h changes.
Approved for Issuance By Date
FINAL INSPECTION APPROVA Date
(Drawing of System on Back)
0
AV
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER 9,0,8 P/-7 PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 hour soak
TEST HOLE N,%1
TEST HOLE No. 2
TEST HOLE No. 3
09
Drop Time
Drop Time
Drop Time
t if
_ 2
04 L
14*
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
AMooAjr
Signature
Go38c Fs A eons � o r-r�g�
OF
Date -71 / ��