HomeMy WebLinkAboutpitkin.eh.264335201002 (1974)®PITKIN
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Owner�Qtii4�
Owner's Mailing Address
® olb/43--'35 o1 -00C
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COUNTY HEALTH DEPARTMENT � �Jnkn sal, br
RECEIPT NUMBER SpA 1 ,0 .
Phone # 22l n �.a
+ Contractor,) �- v Phone #_�
% Address
Systems Contractor's Name
Address L /�
Legal Description' a�T /� 417
Lot Size 3: are--< Type of Building by Use
Number of Bedrooms Type of Water Supply
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock 4 7-
Proximal Location of Ground Water Table%ea
Owner's Signature ' � ' J Date
—
U
PLOT PLAN:
p er inch
Percolation Test Data Minutes
Xxelya&,MA04�
Minimum Recommended Absorption System Size / 9-3 /
Minim R coffinended Tank Size 1 V
Pe t/� lication valid one year from ate. Application to beco pe it and final only
after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE
CONSTRUCITON SITE.
, 2 �� Sanitarian
Date '
(Drawing of system on back)
F34
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0
Section
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COLORADO STATE DEPARTMENT OF PUBLIC HEALTH
DIVISION OF SANITATION Code
ACTIVITY REPORT
FILE REFERENCE: pyivatP �PwagQ n;Gi�Gal
INDIVIDUAL
OR
ESTABLISHMENT
ADDRESS: qtarmnnd
County 57
NARRATIVE: I approved the leach field. The tank, however, was already
loaded, and appeared to be leaking. I mentioned this to one of Ed
Dreager's employees, and he said they would excavate it and see if they
could patch it.
17
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE: October 18 9 19-7-L
ES: 7 (8-53-50)
REPRESENTATIVE: