HomeMy WebLinkAboutpitkin.eh.246717401006 (1976)PITKIN COUNTY HEALTH DEPARTMENT
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PERMIT NUMBER 76053
RECEIPT NUMBER
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Owner C'a� \ _t-- --��� Phone No.
Owner's Mailing Address
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Contractor ������
Address
System's Contractor's Name AI&
Address � y� �7
Legal Description
Lot Size Type of Building by Use-�0��`����
Number of Bedrooms
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Date
Owner's Signature
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System 1 ''
Type of Soil or Soil Classification
Proximal Location of Bedrock T /
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Proximal Location of Ground Water Table
Inch
Percolation Test Date Min tes Pe �6 Z&r
Minimum Recommended Absorption System Size
75-6 _ALL
Minimum Recommended Tank Size
NOTICE
Special Conditions of Issue:/ when properly signed for issuance, this application
S� Ml, ,f p becomes your permit. Application valid one year from
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J�✓�� �Ji1 ; 1sl D ,v date. If an individual sewage disposal permit is issued
for property on which no building permit has been
^ 9 issued, the individual sewage disposal permit shall
expire 120 days after its issuance if construction has
not been commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
11/) the permit, unless approval is secured from the Health
Officer for such than as.
Approved for Issuance By
Date
FINAL INSPECTION APPROVAL
��L�LDate
(Drawing of System on Back)
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