HomeMy WebLinkAboutpitkin.eh.264335103002 (1979)o�i 1p �f3
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER RECEIPT NUMBER 36q,3_,5 --
Owner Drg lD si 1E� i q, Phone No. FA3
Owner's Mailing Address Tl o lr
Contractor S¢ Y� Phone No.
Address
System's Contractor's Name o2 q,k-eo
Address
Legal Description I" Cr 57?g42u-W10 S
Lot Size Type of Building by Use.
Number of Bedrooms `Z _ Type of Water Supply
Owner's Signature-� }�� �Date Si
PLOT PLAN: ATTA6- ED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
')( Proximal Location of Bedrock
V]
NFD — 6ACA T
Proximal Location of Ground Water TableZ-7
SNI' -
�CE b1V01't�j-��r1�i�0_£ icy IeEPuX'T �'-
Percolation Test Date 23 �� /O Minutes Per Inch
Minimum Recommended Absorption System Size 0
Minimum Recommended Tank Size -7-5-0
Special Conditions of Issue: v NOTICE
When properly signed for issuance, this application
2�L�J becomes your permit. Application valid one year from.
311- date. If an individual sewage disposal permit is issue,,
ermn
f / for property on which no building pit has bee
! issued, the individual sewage disposal permit shall
expire 120 days after its issuance If construction, has
r not been commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
l the permit, unless approvel is secured from the Health
Officer for ch changes.
i
i
,pprovta for issuance Date �C
1NAL INSPECTION' APPROVALr / ate /
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Drawing of System on Back)
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