HomeMy WebLinkAboutpitkin.eh.264328204009 (1978)It
PERMIT NUMBER
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,-J PITKIN COUNTY HEALTH DEPARTMENT
RECEIPT NUMBER Pel
Owner M N 'H -WO w ITz Phone No. i
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Owner's Mailing Address �x 2 �Z )F�_A
Contractor ��►/►J� % r Phone No. / ,�
Address J /li �af� SGS `�'° `
System's Contractor's Name
Address
Legal Description LOT S E,I K � �� L � �� ��� C
Lot Size Type of Building by Use Erb 1 OeAJT—I A L
Number of Bedrooms _ `-' Type of Water Supply ?� L�
Owner's Signature Date
PLOT PLAN: ATTACHED AS REQUIRED Cl
Nip �
Type of Individual Sewage Disposal System&CA7-zi) _ i4P �� d PCD
Type of Soil or Soil ClassificationCLAY% 12 S/& _TS_70^/L -7-0 f� 0"alL
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Proximal Location of Bedrock F�T
Proximal Location of Ground Water Table ��T DL7-6-el fjAlJEJ) KXzf7LC 7_7/..4Aj
Percolation Test Date _ Minutes Per Inch
Minimum Recommended Absorption System Size j �T
Minimum Recommended Tank Size %.�0 CAt-&ok) ""`°SET T&O TKLI fZ� - IJT
Special Conditions of Issue: NOTICE
p When properly signed for issuance, this application
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I/S^40��rn�����'Agacomos your permit. Application valid one year from
C C� �f,Y{t�iate. If an individual sewage disposal permit is issued
f _--for property on which no building permit has been
4S � '" L / /�lJ-X issued, the individual sewage disposal permit shall
J ( ^7 \ [�g� expire 120 days after its issuance if construction has
�� �� —6 — /� J7 U _4�773� �� IDo Ew, not been commenced. Any change in plans or speci-
�J J f fications after the permit has been issued invalidates
�riy e)qhA16E 5 Al, (f +Sr PF /l �7 P1? the permit, unless approval is secured from the Health
!/ Officer for such changes.
Approved for Issuance By
Date
7, P
FINAL
INSPECTION APPROVA Date
(Drawing of System on Back)
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