HomeMy WebLinkAboutpitkin.eh.264321307008 (1978)�04, vol
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(�. PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER RECEIPT NUMBER
OwnerC4• Phone No. ?es- /< 3 -
Owner's Mailin Addrr
ContractorZ;M.
Address �e_
System's Contractor's
Address
Legal Description
Lot Size —_
Number of Bedrooms
Owner's Signature —
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me
Ste.
A1Wv4(_ &v&.
5-11V Phone No. _.
4iy6Lea S�
0o.291!2 --57d
CA 3
of Building by Use _
PLOT PLAN: ATTACHED AS REQUIRED
of Water Supply 46;t4_11
Date Z_X2
Type of Individual Sewage Disposal System ,& ZZ/�7,o -
Type of Soil or Soil Classification 5ii-TY OLA 1
Proximal Location of Bedrock Nb - 2 . M l NE -_0 -':::'
Proximal Location of Ground Water Table
AIS 8
C
/�1fi7ZJiE39 L a MOT:
Percolation Test Date Minutes Per Inch /LL _ 67
Minimum Recommended Absorptior
Minimum Recommended Tank Size
Special Conditions of Issue: rvo
p _ When properly signed forr issuance, this application
�/�
i \ (9gE Ame FIL--rEz AtJD BEo becomes your permit. Application valid one year from
Il �
data. If an individual sewage disposal permit is issued
����� P IQ•`j�E D'j/,� for property on which no building permit has been
issued, the individual sewage disposal permit shall
Joy ��' i E� I C�I 9 expire n c 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 fo such hhanges.
Approved for Issuance By
Date
I N P OVAL Date
NAL INSPECT O � ,
(Drawing of System on Back)
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