HomeMy WebLinkAboutpitkin.eh.264321308004 (1975)PERMIT NUMBER 9 1)
Owner
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PITKIN COUNTY HEALTH DEPARTMENT
RECEIPT NUMBER����
6w,neve `Q,/ Phone # Z5
Owner's Mailing Address
Contractor (3 /V1- Phone #
Address
Systems Contractor's Name 53/4 ,411 67
Address
Legal E
Lot Size��
Number of Bedrooms
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location
Proximal Location
Owner's Signature
PLOT PLAN:
Type of Building by Use ! 1AJaC-
Type of Water Supply
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Percolation Test Data
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Minimum Recommended Absorption
stem Size4
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Minimum. Re ommended Tank Size
Permit 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 AT THE
CONSTRUCIT N S TE.
Date Sanitarian
( awing of system on back)
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