HomeMy WebLinkAboutpitkin.eh.264328203005 (1979)OC
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PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER _'IC\C)�-"RECEIPT NUMBER S05
Owner 7/Phone No. — Q_�7.s1 • C
Owner's Mailing Address7.e0�
Contractor A( I' 1 ! P /.,%:�-1 !!:� l'I �,, `n Phone No.
Address
System's Contractor's Name
Address
Legal Description
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Lot Sizel "- Ae. � E-5 Type of Building by Use
Number of Bedrooms Type of Water Supply
,buu LP s Signature At14 Date
i
PLOT PLAN: ATTACHED AS RE R96
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock 6112-EAYE-4 7HA N 19 For,
Proximal Location of Ground Water Table 190EATeo THAM IS ETA
Percolation Test Date I Minutes Per Inch
Minimum Recommended Absorption System Size 337s` S4).F
Minimum Recommended Tank Size 61AW "s A&T�"
Special Conditions of Issue: NOTICE
p When properly signed for issuance, this application
1— OC , srA"6D PER �.�E' o� ja4 becomos your permit. Application valid one year from
� G /U date. If an individual sewage disposal permit is issued
Oir /�'DO &;1'AAfi5,-e1AJC,
for property on which no building permit has been
fLrr`�d P issued, the individual sewage disposal permit shall
/�7/�V expire 120 days after its issuance If construction has
notbeen commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
the permit, unless approval is secured from the Health
11
Officer r such anges.
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Approved for Issuance By Date
FINAL INSPECTION APPROVA =Rmeili7i,4r r
(Drawing of System on Back)
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