HomeMy WebLinkAboutpitkin.eh.264335101003 (1978)U43 - 35 I-��-�03�
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER RECEIPT NUMBER
Owner !' A 0 Phone No.
Owner's Mailing Address &Lc__T_/4k_ Contractor %
Phone No.
1a7-�>C7ao
Address k7y 0e, l "s- -,i� { ) g4_5 '44T.. 4fc;, ff / 6 -L I
System's Contractor's Name
Address �j
Legal Description Z0 I ` 3 :3 57,4 /4 )2- Lel O a
Lot Size S_ A C R E Type of Building by Use s �� A
Number of Bedrooms — V E Type of Water Supply �-
Owner's Signature £ Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock G% I�ET�iE'/L1/16% - Ci0CATe-E'
Proximal Location of Ground Water Table z &rEcc&eIvIAVev - 6- are5e o I -,-T
Percolation Test Date Minutes Per Inch —
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size 7M0 619t-1-e&S:
Special Conditions of Issue: NOTICE
p When properly signed for issuance, this application
becomes your permit. Application valid one year from
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 changes.
Approved for Issuance By Date
FINAL INSPECTION APPROVAL
r Date
(Drawing of System on Back)
To MAIN FINE'
I LLDI� r�t/1AbH
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