HomeMy WebLinkAboutpitkin.eh.264327100002 (1978) (Guest House)PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER —120150 RECEIPT NUMBER
Owner 6�"���'` 0«- ^J Phone No. X qn ��.% <S I
Owner's Mailing Address
Contractor M%nr Qe�ny �n � `� Phone No. ?W7 - 3y77
Address
System's Contractor's Name
Address
Legal Description t
Lot Size "L Cx e &2 -
Number of Bedrooms
3
Type of Building by Use to
Type of Water Supply —EUBDI J1SlonJ �YSTE�
Owner's Signature�,Ajr-loa �ri-Lv, Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classificati
Proximal Location of Bedrock
Proximal Location of Ground 1
,-) €eP,4C6'
Percolation Test Date �" Minutes Per Inch
1/0 t4
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size �Voo GAL-- IC-0AI S
Special Conditions of Issue: NOTICEp When properly signed for issuance, this application
becomes your permit. Application valid one year from
O date. If an individual sewage disposal permit Is issued
forproperty on which no building permit has been
issued, the individual sewage disposal permit shall
expire 120 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 for such hanges.
Approved for Issuance By
Date
17
FINAL INSPECTION APPROVAL ate
(Drawing of System on Back)
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
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TEST HOLE No.1 TEST HOLE No. 2 TEST H LE No. 3
Drop Time Drop Time Drop Ti e
115
a
8� I ¢
Percolation Rate Each Hole .3% _311_ /&U
Average Rate 75 eO Fe PCS16AI
Comments on soil or site:.
u 614A
Signature
Date
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T �
21
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46