HomeMy WebLinkAboutpitkin.eh.264504303026 (1974)1,- 4TKIN COUNTY 11EALTH DEPARTMENTQ
PERMIT NUMBER 91 720211 RECEIPT NUMBER l ;O
Owner �l C lid i� �iS' �/ . ,� Ly ,S' Phone N
Owner's mailing address A6o��!/ 7 6 � ,&w s.gZ %/
Contractor U c,E'-% S /L yjfi/_% Phone #f
Address 60
Systems Contractor's Name
Address
Legal Description ' lo %- 3 .f-
Lot size g a o ?e --400 Type of building by use o y,R �
Number of Bedrooms -Z . Type of Water Supply bJ rQ�
Type of soil or soil classification
Proximal location of bedrock
-'
Proximal location of ground water table 7 %
Type of indiNridual sewage disposal system.
Plot Plan
Percolation test data 15 3
Minimum recommeded absorption system size 113;2-e
Minimum recommended tank size /2- ,T-0
MINUTES PER I CH
Permit application valid one year from date. Application to become permit and final
only after lower portion is completed and signed by the Sanitarian. Ret in this form
at the cons truction site. t-V4
�
DATE SANITARIAN
(Drawing of system on back)
•
0 Apm. -
,i{- i 0 CO DEP E T F HEALTH
COUNTY .J 7 REQUEST SERVICE
PROGRAMnn R//E``CE I VE D BY
LOCATION V I, NAME (�-
REPORTED BY
DDRESS
TE :3Z,2 7
TELEPHONE
SH -M-71 (4-71-50)