HomeMy WebLinkAboutpitkin.eh.264335203006 (1976)PITKIN COUNTY HEALTH DEPARTMENT
76059
PERMIT NUMBER
Owner r
n
Owner's Mailing Address 03$(� JOHN
Contractor
Address
System's Contractor's Name
Address
1aE
�u43 3& D_
P-CA50n
RECEIPT NUMBER
Phone No. C, C�
Phone No. q, LS — S CD t
Legal Description I CL cl °
Lot Size
Type of Building by UsL
Number of Bedrooms Type of Water Supply
Date
Owner's Signature
PLOT PLAN: ATTACHED AS REQ ED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification/d r
0
Proximal Location of Bedrock
�--2:-AA., A rte/ � f_��l �,P 711A 11
Proximal Location of Ground Water Table
Percolation Test Date
Minutes Per Inch
Minimum Recommended Absorption System Size 1-,`-!Ka/.lea /�
Minimum Recommended Tank Size/, 5 -e -o 6-4L4,411/S — _rzz1e�)
NOTICE
Special Conditions of Issue: when properly signed for issuance, this application
7-t) � l��! A&LED AT becomes your permit. Application valid one year from
^ te. If an individual sewage disposal permit is issued
6Z:-_40&J
�/ /�� CX/'�Q f/( O F3a for If
on which no building permit has been
L-C.�G� vV��! JJ issued, the individual sewage disposal permit shall
^ r �o6/1D69 expire days atter its issuance if construction he
7-6�f6•J�G1i- s
not been
commenced. Any change is plans invalidates idatspeci-
fications� eperafter the permit has been issued invalidates
the permit, unless approval is secured from the Health
Officer for such hanges.
Approved for Issuance By - Date
FINAL INSPECTION APPROVAL IZA
(Drawing of System on Back)
E
fLACC TANK � 251,06
_MPIAIC. COAMa.0-
- -y1' WA LL