HomeMy WebLinkAboutpitkin.eh.264504303034 (1973)test data � ^'�' minutes per inch 13lx /00,,
Minimum recommended absorption system size 6 Q � 0
Minimum recommended tank size doo r" o, (�on,-'I .
Permit application valid one year from date Application to become permit and
final only after lower portion is completed and signed. Retain this form at
the construction site.
DRAWING OF SYSTEM f�
I 250
p o CA LLD'
d u5E �L T*
ly. y
30
Date / a- �� Sanitarian
PITKIN
COUNTY HEALTH
DEPARTMENT
PERMIT NUMBERRECEIPT
NUMBER
Owner s
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Phone
Address
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Contractor
Phone
Address
Location of
system
Lot Size
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Legal description
Date
Date �n
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SiGanture of
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test data � ^'�' minutes per inch 13lx /00,,
Minimum recommended absorption system size 6 Q � 0
Minimum recommended tank size doo r" o, (�on,-'I .
Permit application valid one year from date Application to become permit and
final only after lower portion is completed and signed. Retain this form at
the construction site.
DRAWING OF SYSTEM f�
I 250
p o CA LLD'
d u5E �L T*
ly. y
30
Date / a- �� Sanitarian
` COUNTY
PROGRAM
LOCATION
REPORTED BY
COLORADO DEPARTMENT OF HEALTHI
REQUEST FOR:SERVIOE
RECEIVED BY rl k DATE
N AV
e IIW611 ADDRESS TELEPHONE
SERVICE REQUESTED I/�/ eZ,
d P 4 S."AS
T - Lj• / r
ACTION REPORT
ACTION BY DISPOSITION
DATE
SH -M-71 (4-71-50)
COUNTY
LOCATION Li
REPORTED BY,
COLORADO DEPARTMENT OF HEALTH
REQUEST FOR SERVICE
n �
:E I VED BY /��r=� --DATE
NAME
i
SERVICE REQUESTED r yi c fob- 'a .ti h n .r — -1-i�,
TELEPHONE las 412/lfK
DATE
H -M -7i (4-71-50)