HomeMy WebLinkAboutpitkin.eh.264523200006 (1975)a�5 - a33 -00- ocq5 S�
O
i' PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 7 20,� `� `3 ac RECEIPT NUMBER 190,V -
Owner
Owner's Mailing Address
Contractor
Address
Systems Contractor's Name
Address
Legal D
Phone #
Phone #
ek. A"
Lot Size :570 D C,- 0/ Type of Building by Use c -,5i, -V
Number of Bedrooms �w .� Type of Water Supply
Type of Individual Sewage Disposal
Type of Soil or Soil Classification ,ZmAf ►Tb �/� 11� e � �✓� ��A
Proximal Location of Bedrock /V07—E R/
Proximal Location of Ground /Watr Table
Owner's Signature Date.__L
PLOT PLAN:
Percolation Test Data Minutey/per inch
Minimum Recommended Absorption System Size
Minimum Reco end d Tank Size ,5-0 ? U
"Vi�d n valid one ear fr Date. Application to bec ermi and anal only
7 oPermY
after lower portion is completed and signed by the Sanitarian. ETAIN THIS FORM AT THE
CONSTRUCILNITE Date 7 Sanitarian
(D awing of system on back)
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