HomeMy WebLinkAboutpitkin.eh.264335105001 (1975)I
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PITKIN COUNTY HEALTH DEPARTMENT
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RECEIPT NUMBER/
PERMIT NUMBER (d2 f i 3
r
Owner L Lc )/J L.--! /� A tj Phone #
Owner's Mailing Address P a, Ye / LI) � � / ASPCA)
Contractor A� L..t V l AJs0 AJ Phone # 92s-- T �
Address
Systems Contractor's NameTi!%l�•,%�ItC
Address
Legal Description /1 t0
Lot Size 41-t,AC,eF.T
Number of Bedrooms q
e of Individual Sewage Disposal System
Is
Type of Building by Use
)I 16LC /XMlc'/
Type 'of Water SupplyC.�/llfWi4�(-S78�0& �TAPW66D
Zyp
Type of Soil or Soil Classification Lo/
nJO 7lE(J, �_-UiY
Proximal Location of Bedrock /y�
Proximal Location of Ground Water Table 141ei D T6"LIiN
Owner's Signature I Date -
PLOT PLAN:
WEE0
7/ 17-5-
Percolation Test Data — 3 — Minut(33,s per inch
p Sy Dao-d�
LX6
Minimum Recommended Absorption stem Size
Minim Recommended Tank Size
2SD l �
Pe it/ application valid one year fro Date. Application to become permit and final only
after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE
CONSTRUCQITON SI E.
Date V Sanitarian
( rawing of system on back)
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HOUSE AmAwD
CARACC
1250 GALLar1 CMCRETc
_ p (,OPELAN4 SEPrIe.,T�WK ,�C ST
Ko
R LINE
7�
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APPRoXInMTE
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• �'!'° COLORADO DEPARTMENT OF HEALTH O
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COUNTY REQUEST FOR SERVICE
G �
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y PROGRAM �'��- RECEIVED BY �J DATE O
LOCATION tJ7Gc �n-��,"'�/ NAME G�iCt rI
REPORTED BY ADDRESS TELEPHONE
SERVICE REQUESTED 4�1/
ACTION REPORT
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ACTION BY
SH -M -7i (4-71-50)
ISPOSITION
/N O
DATE