HomeMy WebLinkAboutpitkin.eh.264322400011 (1974) (Barn-CDU)PERMIT NUMBER
Owner X10
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PITKIN COUNTY HEALTH DEPARTMENT
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9 20 , 2," °� � RECEIPT NUMBER 7
Phone # 9,2 s-- 3V 33
Owner's Mailing Address I D ,,i
Contractor
Address
Systems Contractor's Name
Address
Legal E
Phone # nd j- - `7 S )
/61
Lot Size *C 0 V(
Number of Bedrooms
Type of Individual Sewage Di
Type of Soil or Soil Classif
Proximal Location of Bedrock
Type of Building by Use ,Z
Type of Water Supply
Proximal Location of Ground Water Table / z 74- /
Owner's Signature Date'
77, vyyl '
PLOT PLAN:
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Percolation Test Data
Minimum Recommended Absorption System Size
Minim Re om�ended Tank Sized L'
Pe it plication valid one year from Dat
after lower portion is completed and sign
CONSTRUCITON SeITE
Date �O
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ed by the Sanitarian. RETAIN THIS FORM AT THE
Sanitarian
(D wing of system on back)
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