HomeMy WebLinkAboutpitkin.eh.264916101022 (1974)LDAq- M l G
PITKIN COUNTY HEALTH DEPARTMENT ,,X3C"tv
PERMIT NUMBER 2 0j 2 ") I RECEIPT NUMBER / 7
Owner
Phone # 94/ Jr-
Owner's Mailing Address
Contractor \l'S -1 �-'' L i d i`L1 s� Phone # q4s- to l (YO
Address_
Systems Contractor's Name
Address
Legal Description P &7- It)'
Lot Size
Number of Bedrooms
Type of Individual Sewage Disposal
Type of Soil or Soil Classification
Proximal Location of Bedrock
Type of Building by Use
Tvne of Water Supply
Proximal Location of Ground Water Table R
Owner's Signature Date -,,. L147�
PLOT PLAN: A
Percolation Test Data
Minimum Recommended Absorptio.
Minimum Recommended Tank Size
--AC—Minutes per inch
Permit application valid one year from Date. Application to become permii ana ilna.i U11 -LY
after lower portion completed d igned by the Sanitarian. RETAIN THIS FORM AT THE
CONSTRU ITON SITE.t f"�r
4 7-f
Date Sanitarian
(Drawing of system on back)
NoR�r�
C64CRErE TANK
— DF -y
/6 ` DOM eTEP
/o' I?E� p
C0NCPETE- 21 fq S
COUNTY s7
COLORADO DEPARTMENT OF HEALTH
REQUEST EOR .5ERVICE
PROGRAM RECEIVED BY
LOCATION NAME
REPORTED BY ADDRESS
SERVICE REQUESTED
. S
DATE/Z 7
,3j6TELEPHONE 4?X5 160
ACTION REPORT
ACTION BY DISPOSITION iL A
DATE
SH -M -7t (4-71-50)
COLORADO DEPARTMENT OF HEALTH
COUNTY REQUEST R RVICE
PROGRAM / RECEIVED BY DATE
LOCATION NAME
REPORTED BYADDRESS �� TELEPHONE
SERVICE REQUESTE
ACTION
ACTION BY
DATE 5 /
SH -M-71 (4-71-50
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