HomeMy WebLinkAboutpitkin.eh.264335107004 (1973)(#4 004
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PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 720195 RECEIPT NUMBER ( -�Z
Owner r?Cl,Q�t�G�� Phone #
Address "7t
Contractor Phone #
Address 5 -7
Location of system oz� 9 / Lot size o� �CAe-,
Legal description
Number of bedrooms ✓? Date CJ✓ �%
Signature of owner
Percolation test data minutes per inch
Minimum recommended absorption system size�r2C�
Minimum recommended tank size 0Q
Permit application valid one year from date. Ap ation to become permit and final
only after lower portion is completed and signed. Retain this form at the construction
site. `V
DRAWING OF SYSTEM
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Sanitarian
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COLO.,RADO- DEPARTMENT OF HEALTH
Water Pollution Control Division
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
I
Mail Address: City: Phone:
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
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 �u� City or Town
Legal Description 4-/, Lot Size:
2. Type of area and facility - Number of persons served:
Subdivision ! _ Motel Restaurant Trailer Court
Other:
3. Source of domestic water: Public (name): L(J
Private: Well Depth Other Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District: 72.1>
If so name:
5. Distance to nearest sewer system:
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.Jevel after
holes have been soaked for 24 hours: f ( �/4t�. vow e L�� zJL L -vi --C
7. Name, address and telephone of person who made soil absorption tests:
C .,,., %>. 12 f C
r '�; C'r ' r- /-���
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