HomeMy WebLinkAboutpitkin.EH.264335105006 (1974)PERMIT NUMBER `� ; PITKIN NAY LTH DEPARTMENT RECEIPT NUMBER �/
2- .5 - !1 87
Owner {�c> � Orr 1.5 Phone # 91�-`��t87
Owner's Mailing Address qE ►-P������ i5�+�, ��orc�0 8/6�!
Co�� Cara
Contractor C-t'cru='yi ►'}io�,•� "^ ns Phone # 2 `-� —'4 36•�
Address ax aO1 Z ,1r 12CE-11 aio rct-A o
Systems Contractor's Name
Address
Legal Description
Loi' R Sit Sly r �voca�
Lot Size Jr�Zcr-CS
11 1 Number of Bedrooms
Type of Building by Use (-rV,a �-� �'c'r►�
Type of Water Supply dG rn,es 9c..
Type of Individual Sewage Disposal System SGS PTIC,
Type of Soil or S
Proximal Location
Proximal Location
Owner's Signature
PLOT PLAN:
CA-o� >T)k
Percolation Test Data Minutes per inch
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
1 I�L-S'0 j
Permit application, valid one year from Date. Application to become permit and final only
after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE
CONSTRUCITON SIT .
Date Sanitarian
(Dr ln g of system on back)
*As