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PITKIN COUNTY HEALTH DEPARTMENT
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PERMIT NUMBER v � RECEIPT NUMBER 2-7709
Owner .21L.16-1 Cee {? p r Phone No. 9 a s"_S -3 9Z
Owner's Mailing Address 13 0 1 1As k f1s�� C d 10
Contractor
Pet -r -c e h., _ k Phone No. g j�- 3 a 4 g
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Address 6 373 F 5eoc; s Creek RA C,jachojkmI-e
System's Contractor's Name b o la ncd� °Ua %j sl -M rr-
Address 1813 Muer UJ000%•t C. deck Colo
Legal Description R S (e 51`a� w eodt R /tony _5t0rc,
Lot Size y a-0 Type of Building by Use R s � ckeyt ,� 1
Number of Bedrooms 3 Type of Water Supply S Aeu. CVC
Owner's Signature
�—z _- Date
PLOT PLAN: ATTACHED AS REQUIRED
IN -T -OA D"06ra
Type of Individual Sewage Disposal System �pTIC TANK-- �fEPACe i I T ( L1M17�r7 SPffr��
Type of Soil or Soil Classification / 0,4,14 TO ��/� �Z/�i T� �y��-J ¢ S/`�/U�/��t�
Proximal Location of Bedrock
Proximal Location of Ground Water Table / �a �E��'%� � �'� � 7HAA) FT
Percolation Test Date _ 2--2-Minutes Per Inch
Minimum Recommended Absorption System Size Z, el, SE2
Minimum Recommended Tank Size /22,00 CAGG�J��
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S ecial Con itions of Issue:
P When properly signed forr issuance, this application
0AI 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 l
FINAL INSPECTION APPROVAL
�2� Date /
(Drawing of System on f'tr,snf