HomeMy WebLinkAboutpitkin.eh.264514401006 (1979)Q Go 45-- '144 — Gi! —CvCP
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER - mob
57-3,-), Sh&ww,"5 c -v k
RECEIPT NUMBER
31 S�
Owner C�f.4�L \AAIE Phone No. 22-3-sf77
Owner's Mailing Address 86?,- 290 ASPEAi
Contractor &Z LJAIKEK Phone No. *3-'-Y(- -L Ge 9Zs-2.fss-
Address �� iSv9y ASPS
System's Contractor's Name /��'�J K ��styc-)p
Address
Legal Description 1,0 & -
Lot Size _5_ a_r Type of Building by Use R,-3
Number of Bedrooms
Owner's Signature
3
PLOT PLAN: ATTACHED AS REQUIRED
Type of Water Supply
Date 9-17-72
Type of Individual Sewage Disposal System . 'OEME! M1NFW Lo_w"
Type of Soil or Soil Classification LOAM -70 QW& W VT -
Proximal Location of Bedrock
EM
Proximal Location of Ground Water Table OT oc-re-ewl len --, SFT.
Percolation Test Date /101- 7? Minutes Per Inch
410 x 0
Minimum Recommended Absorption System Size —':::;I F77 gorj - I Vj
Minimum Recommended Tank Size 1.7-S-0 CA44DAfS a _ �C)00 1 : 1,' S D
Special Conditions of Issue:1k 5 ++ NOTICE
yd } a When properly signed for issuance, this application
nn p�q .LcQ + Sbecomas your permit. Application valid one year from
AI,? �` date. If an individual sewage disposal permit is issued
/ r ri forproperty on which no building permit has been
tO � <- _ of L9 � issued, the individual sewage disposal permit shall
i1'twli�(K) ^�`�`� `J expire 120 days after its issuance If construction has
�p ( pp not been commenced. Any change in plans or speci-
1��QC Si �C fhfe per after the permit has been issued invalidates
,�{J the permit, unless approval is secured from the Health
" t6o Officer for such changes.
Approved for Issuance By
Date /D �r_77
FINAL INSPECTION APPRO
V'000001A
(Drawing of System on Back)
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Pitkin County Environmental Health Department
Contact Log Sheet
Name:
ParcelID#: Address:
Date Person S oken To Comments / Action to be Taken Initials Time
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