HomeMy WebLinkAboutpitkin.eh.264504201018 (1977)3 -
PITKIN COUNTY HEALTH DEPARTMENT
HERMIT NUMBER / RECEIPT NUMBER
Owner �'�/`S�� Phone No. 9�3SSS—
Owner's Mailing Address
Contractor Phone No. s��€
Address
System's Contractor's Name
Address
Legal De
Lot Size (-->` - C'` Type of Building by Use
Number of Bedrooms
Type of Water Supply lv/7'iru///'`y' crr�il�x SYl�7
Owner's Signature : r Date ZI
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System M— WI J 1AJ_A11V/t 1U% /trAi! — W/rrul& �>✓1�lT//vN F��a1
Type of Soil or Soil Classification : 1Li 7�r') 20 CZA�I�9-L AYLl�'� i�Ur!'1 1rLJTiI
Proximal Location of Bedrock l( e A- t;e % %frig 1T
Proximal Location of Ground Water Table �� F
Percolation Test Date Minutes Per Inch
Minimum Recommended Absorption System Size =2/tIc ET
Minimum Recommended Tank Size 1`� � � �� � � � % &�44r
Special Conditions of Issue: NOTICE
When properly signed for issuance, this application
f� becomes your permit. Application valid one year from
/ (Jv7,PC IAJ J IA �—D LL_ PO4� A�X S X/0 date. If an individual sewage disposal permit is issued
I' for property on which no building permit has been
,SP60,1F1 147_1e 1S e5 � 6_D6,P1006W1NC'e4S issued, the individual sewage disposal permit shall
ti expire 120 days after its issuance If construction has
��� not been commenced. Any change in plans or speci-
J1:J fications after the permit has been issued invalidates
the permit, unless approval is secured from the Health
Officer for such changes.
Approved for Issuance B ��" L '' ` Date ,�
pp Y
FINAL INSPECTION APPROVAL Date
(Drawing of System on Back)