HomeMy WebLinkAboutpitkin.eh.264322302002 (1974)2 0 2"� � PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER RECEIPT NUMBER %�' TO
Owner A
Owner's Mailing Address
Contractor
Address
Systems Contractor's Name
Address
M
Phone # ?,Z57 - Z /.1
Phone #
Legal Description
Lot Size 0, Type of Building by Use P�� itlC
Number of Bedrooms _ Type of Water Supply dCA17VAI. Au,
-
Type of Individual Sewage Disposal
Type of Soil or Soil Classification
Proximal Location of Bedrock zi
Proximal Location
Owner's Signature
PLOT PLAN:
0
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Percolation Test Data
Minimum Recommended Absorption System Size
Minim Re ominended Tank Size U
7
Pe t pli at valid one year from Date. Application to t
after lower portion is completed and sign
CONSTRUCITOD SITE.
Date 7 7�
ed by the Sanitarian. RETAIN THIS FORM AT THE
Sanitarian
(D awing of system on back)
t ti
140 u s�
A QoXIMA'RLY
22oo" To LuATEx
SUPPLY PUMP it 7
-* # a I?
ORI V97 0 1250 c,Au..a�
CONCwm VICP
o SEM c 'TANK
_ 17i _
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