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HomeMy WebLinkAboutpitkin.eh.264514402002 (1978)_VOID«irnl�I. *. 4 was' 6" 5 'PITKIN COUNTY HEALTH DEPARTMENT %L,,1�Q PERMIT NUMBER �b�� RECEIPT NUMBER v Owner J I Nt,_1 DK-� N)FLLP hone No. �7 I Owner's Mailing Address Contractor Phone No. Address System's Contractor's Name Address Legal Description 22130 ASs V PP-� ' C S 5_UE)LLVL St 611.E Lb7 * 2- I rit Lot Size C� N ' Type of Building by Use ovwu Numher of Bedrooms Type of Water Supply Owner's Signature Date PLOT PLAN: ATTACHED AS REQUIRED Type of Individual Sewage Disposal System Type of Soil or Soil Classification Proximal Location of Bedrock clh J/ o"'© ,, / —7 Proximal Location of Ground Water Table Percolation Test Date Minimum Recommended Absorption Systerp Size Minimum Recommended Tank Size Special Conditions of Issue: Approved for Issuance By FINAL INSPECTION APPROVAL (Drawing of System on Back) Minutes Per Inch Date Date NOTICE When properly signed for issuance, this application becomes your permit. Application valid one year from date. If an individual sewage disposal permit is issued for property on which no building permit has been 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 such changes.