HomeMy WebLinkAboutpitkin.eh.264321302019 (1975)PERMIT NUMBER 2 2 � 1
k Owner
Owner's Mailing Address
Contractor
Address
Systems Contractor's Name
Address
Legal Description
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PITKIN COUNTY HEALTH DEPARTMENT
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RECEIPT NUMBER
Phone # qZ�a"`'t� 7G
Phone #
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Lot Size i Type of Building by Use J1�Wi e k hVle We
Number of Bedrooms Type of Water Supply
Type of Individual Sewage Disposal Systeme ®5� //1�67�(
Type of Soil or Soil Classificati2n
Proximal Location of Bedrock Jwi'/ /_/f ! C"!q( fV
Proximal Location Gr and Wa Table
Owner's Signature
Date�ry '
PLOT PLAN:
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Par(-c)l_ation Test Data Tv Minutes per inch j
Minimum Recommended Absorption System Size -27e) s
i°WAL (3,
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Mini um Recommended Tank SizeI L -w'" •-&iv i
Pe i application valid one year from Date. Application to becom permit and final only
after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM T THE
CONSTRUCITON ITE'.
ejDate Sanitarian � � -
( awing of system on back)
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