HomeMy WebLinkAboutpitkin.eh.264504303021 (1977)PERMIT NUMBER
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PITKIN COUNTY HEALTH DEPARTMENT
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RECEIPT NUMBER3�c?�—���
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Owner Ja i'1 4e 5 %� , G l 6 6 a r Phone No. �� -� " ? 7
Owner's Mailing Address 66 1� 2 6 -1b I� �pe-/I
Contractor 0 ('Z h 'e r Phone No.
Address
System's Contractor's Name
Address
Legal Description
Lot Size— / C4e r �- Type of Building by Use re J 1 JA t, c e
Number of Bedrooms Type of Water Supply
Owner's Signature Date ,Zj ,:'Z % %
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification J y LOAA1 %d /����
Proximal Location of Bedrock �V�'`� 7 TE�i�'I/itlC (� – G.2 O4 � 7H_ 1q F% -
Proximal Location of Ground Water Table 7�/ `/ ON 1 ///
Percolation Test Date61171-72 /— Minutes Per Inch
Minimum Recommended Absorption System Size / SQ' F-7
Minimum Recommended Tank Size
Special Conditions of Issue: NOTICE
When properly signed for issuance, this application
FIELD MUST I3C 1AI TALL.E P-) LV 1 V/ becomes your permit. Application valid one year from
date. If an individual sewage disposal permit Is issued
/ ' M,411MC M DEPTH ^L /7 Q IIVC, _S for property di which a building permit has been
'_I DEPTH 7 V6 �G (� �I/C /7 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
the permit, unless approval is secured from the Health
Officer for suc changes.
r ved for Issuance By
/ Date
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FINAL INSPECTION APPROVAL
�'��– Date �71 7
(Drawing of System on Back)
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet o Percolation Test
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system �% ►r If
Test Hole Depths (24" minimum)`
45
Diameter of Test Holes rf 15"
Water remaining after 24 hour soak r 0
TEST HOLE No.1 TEST HOLE•
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11rop Time• . . Time 11rop Time
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Percolation Rate Each Hole
Average Rate
Comments on soil or site:
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Signature
Date G/, 7 17
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