HomeMy WebLinkAboutpitkin.eh.264335105007 (1970)_APPL FOR SEPTIC LOCATION3 �/ - D =Mw%xf*-COLORADO DEPARTMENT OF HEALTH Aog3 - 0
Water Pollution Control Divisiong,��o�� �y
4210 East 11th Avenue '�"
Denver, Colorado 80220 Aspen' Col®
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
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Mail Address: �I)aCk1
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A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Ph- ne:�_�53c�0
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes.
1. Location of Facility: County p,`L- La City or Town A:,2PV"'
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Legal Description �-.0 /Q-67. Lot Size: ,256 A,
2. Type of area and facility - Number of persons served:
Subdivision Motel
Other: f71DA"401, —
-
Restaurant Trailer Court
3. Source of domestic water: Public (name):�r,
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District:
If so name
5. Distance to dearest sewer system: 5 -"�
Have negotiations been attempted with owner to connect:
If rejected, give reason:
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours:
7. Name, address and telephone of person who made soil absorption tests:
8. Name, address and telephone of person responsible for design of the system:
9. Est. bid opening date: Est. Completion Date: Est. Project Cost:
/Date.
Signature of Owner