HomeMy WebLinkAboutpitkin.eh.264322211003.264322211004 (1977)1
PITKIN COUNTY HEALTH DEPARTMENT -1 -2---L-
PERMIT
ZPERMIT NUMBER 7//°?- / RECEIPT NUMBER
OwnerlcL
�/��� �14)czerAJ — ���TDi✓ �k Phone No. !-��– 72 11
Owner's Mailing Address 4 • '--/c'A z o`er -Z
Contractor
Address
Phone No.
System's Contractor's Name h C, ,�ERertc- N
ic
Address
Legal Description
V
Lot Size Type of Building by Use V PL ft - UN/1-5 It
Number of Bedrooms - Type of Water Supply —L -L
ls
Owner's Signature Date Z/
PLOT PLAN: ATTACHED AS REQUIRED
peof Individual Sewage Disposal SystemD
ype of Soil or Soil Classification) ,.
Proximal Location of Bedrock
Proximal Location of Ground 1
Percolation Test Date
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
Special Conditions of Issue:
/(0
0
Minutes Per Inch
NOTICE
p When properly signed for issuance, this application
becomes your permit. Application valid one year from
MA)
� `� �' date. o e individual sewage disposal permit
Is issued
i� /ITCH -/J for property on which no building permit has been
issued, the individual sewagedisposal permit shall
expire 120 days after itsis issuance If construction hes
/41 not been commenced. Any change Is plena va spocl
idates
Z fications after the permit has been Issued invalidates
��/��//�—• the permit, unless approval is secured from the Health
r Officer for such c nges.
RAI
Approved for Issuance By
Date
FINAL INSPECTION APPROVAL
l r /AX
ate 1�22
(Drawing of System on Back)
Address
Systems Contractor's Name
Address
Legal Description
Lot Size
2 Aa ee,
Number of Bedrooms 7 'f
N
Type of Building by Use jSd)EiUCE
Type of Water Supply ��i4t- /M1 --Z
Type of Individual Sewage Disposal System—:;,EPTIOC 1ANK
Type of Soil or Soil Classification
Proximal Location of Bedrock -> ? v
Proximal Location of Ground Water Table_Qwnp
er's Signature��
4;LOT PLAN:
Date 1�71Ll '
Percolation Test Data Minutes per inch
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
M
Permit application valid one year from Date. Application to become permit and final only
after lower portion is completed and signed by the Sanit i BETAI THI F AT THE
STRU ITON SITE. /�
���� Sanitarian
Date � � ��
(D awing of system on back)
Q
PITKIN COUNTY HEALTH DEPARTMENT
RECEIPT
/� (`
NUMBER &C TO J J-01
PERMIT NUMBER
%SEI
Owner Com' f� /1`�fa
'` �i'(�l/- -iG/� `JAFfr�E- jr
, _
Phone #
47. 5" 7 1
�ner's Address
Mailing
�tIQ �fTF,�
1t1A,1JA6E-i,
Phone #
SAME AS 64?P,
Contractor
Address
Systems Contractor's Name
Address
Legal Description
Lot Size
2 Aa ee,
Number of Bedrooms 7 'f
N
Type of Building by Use jSd)EiUCE
Type of Water Supply ��i4t- /M1 --Z
Type of Individual Sewage Disposal System—:;,EPTIOC 1ANK
Type of Soil or Soil Classification
Proximal Location of Bedrock -> ? v
Proximal Location of Ground Water Table_Qwnp
er's Signature��
4;LOT PLAN:
Date 1�71Ll '
Percolation Test Data Minutes per inch
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
M
Permit application valid one year from Date. Application to become permit and final only
after lower portion is completed and signed by the Sanit i BETAI THI F AT THE
STRU ITON SITE. /�
���� Sanitarian
Date � � ��
(D awing of system on back)
(1( 4-
Ovi 7-5 16417
FENCF"
r
26 c
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C� .JRADO DEPARTMENT OF HEALTH
f e
COUNTY V REQUEST FOR SERVICE
PROGRAM /y RECEIVED BY DATE
.1-ATION ��' ��C'.V NAME o .. ✓ �.LC?�'
<�. RTED BY ADDRESS /� �(/// TELEPHONE
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SH—M-71 (4271-50)