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HomeMy WebLinkAboutpitkin.eh.246334300015 (1978)- - _ Q4(03 -- - A 3 -oG 7166 ly 133 PITKIN COUNTY HEALTH DEPARTMENT Q PERMIT NUMBER D RECEIPT NUMBER Owner en h e -f -r Phone No. 253-309a Ise g -1 (f/eA7'� Owner's Mailing Address /O C��, � � PO, Zox 192- Car6l / mU-ala 0-0 Phone No. Contractor ` ` - Address System's Contractor's Name Address Legal Description Se C, �7 � � s � Lot Size �� �e� Type of Building by Use s_� 1e �< <y �esiJe c� Number of Bedrooms Type of Water Supply ire- ( I Owner's Signature Date `Jt t Lt s r .2 7 a -s -e -r►,- i?,o b-e_rT V /; o•rr- PLOT PLAN: ATTACHED AS REQUIRED Type of Individual Sewage Disposal System /" I /C, /A -1/y /c Type of Soil or Soil Classificationn�D�Z-/ Proximal Location of Bedrock �//A � g Proximal Location of Ground Water Table �,�E j _7;q14A1 R" FT Percolation Test Date -279 -21 Minutes Per Inch Minimum Recommended Absorption System Sizer)'V 0 Sok' F-7- MinimumRecommended Tank Size —,Z2�© CALL_)4/� Special Conditions of Issue: NOTICE /I When properly signed for issuance, this application becoos your permit. Application valid one year from LO 4TE.4,6S61C�r16iV A/ELjO date. mIi an individual sewage disposal permit is issued ��/%����� I� for property on which no building permit has been /!� issued, the individual sewage disposal permit shall _25 -expire 120 days after its issuance If construction has o not been commenced. Any change in plans va idatspeci- fic s fications after the permit has been issued invalidates the permit, unless approval is secured from the Health Officer fors h changes. Approved for Issuance By / Date iE it iF i! it iF ih it tt it iF at 9t iF iF M M it iF it iF �F iF iF aE it * iF iF jE it t iE it iF X it 4t iF iE 9t it 9t iE jE iF it at it iF iE at it at it iF it �t it ie iF it � it iF jt it it iF * tt 9t at iF it it * * ie it iF * 1F it tt FINAL INSPECTION A PPROVA WWV .. Date (Drawing of System on Back) MODULAR HooSE C�u�a AGE � �C,LEANo Ur o, c 12So GALl,.GrN ' IAepTie-TANK wrrN R ©ISTR�Bimo�J � i DR -1 g� p E EN 1 8' 3R/ ARK I^16 To w Ec L- PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER Z- LL% O Gc �RLf G H i 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 f ,1 TEST HOLE No. 3 Drop Time r,> 3 B� TEST HOLE No.1 Dro Time TEST HOLE No. 2 Drop Time TEST HOLE No. 3 Drop Time 3 B� 3 Percolation Rate Each Oole i Average Rate 2 Comments on soil or site: , Signature Date � ` 23� j Y