HomeMy WebLinkAboutpitkin.eh.264335200006 (1992)_USE PERMIT APPRBQpEr Fit n[11 M AM SEMC, a71a711:i7 116C17MON
USE pMMr MPUCATION
Date Requested � }"
Bill TO , i — -c � ' Oxy=-A-�c
Inspection Requested By_ =
original Report To Be Sent T<
Copy of Report To Be Sent To.
pq SON:
Property Owner � i
Parcel ID Number.
Legal L4,
Loth_, Block_
Address_ 1 D ,
Building Occupie
Date septic Tank
Check/Receipt
j
Vacan Age Of
t #Beds
EPAIMM RECORDS: y Year Issued _/ /'/ No Records ound
Permit Number () Septic Tank Material et
Septic Tank Cacz (Sq. Ft.) Leach Field Type 2EEri��� % 5
Leach Field Size
ZON: 7/
Date Of Inspection ! Inspector «' Covered_ Other. . .
Soil Conditions:Dry _ated_ Not Functioning
Septic System: Functioning tisfactorily�
� C,anunents:
Water Supply: Public: Name o ► ti
�e
Private: Well -f Spr , Cistern_, Surfaces f
Other
Well Construction And Locations QnaAPPr
ppreodved use
Date
Bacteriological Water Test: Number
pcele
other
A.P.E.H.D.:4/87 �, 7