HomeMy WebLinkAboutpitkin.eh.264921301006 (1973)0
U49 -a -'0 1 - 0-0 6
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER RECEIPT NUMBER I
Owner �V A �'L-,� �d F S A Phone
Address CvC% 1c tic j� I sc) u
Contractors �' (_ l.- iG �Z Phone
Address
Location of system CRY ci (6 L QNUe,)�)RL G 7 Loot Size
Legal description
Date Siganture of owner
Percolation test data 'S , % �; minutes per inch
Minimum recommended absorption system size % 5 "d—e
Minimum recommended tank size 1 000
Permit application valid one year from date. Application to become permit and
final only after lower portion is completed and signed. Retain this form at
the construction site.
DRAWING OF SYSTEM I 4
I
A G134 Tt, o> p L vv T
Date LJ I 'l / q-3 Sanitarian
ti Ce ,U L'e
I
?CII T
StORADO DEPARTMENT OF HEALTH r
DIVISION OF ENGINEERING AND SANITATION
ACT I V I T Y RE PORT Code
Section County �`T�i/1✓
FILE REFERENCE: mal
INDIVIDUAL OR
ESTABLISHMENT: :24L t 721-L4 lt/
ADDRESS:
NARRATIVE: •� _ '
-liGC. .�Z�c�Lt� a.t/ / � .v^ "� �.c,.-� /oZ.�q��c, ��-�ic.o•or✓t
s
3x 3 75 -�
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:—, 19� REPRESENTATIVE:
ES: 7 (Rev. 6-70-100)
,m
0� 6# q —.v2/3 — )/ - 4)&
115 38'� 133
NW -1/4 SW 1/4
SEC. 21
� TR. t!
ss' a
EOUTN
CAST 167.41'
If
WEST TTTws'
ti
AST MTV
V
rw. tr
q•
wtsT ns.o'
o
3 S7 rR,is
v
T�
-14.9E' TST
209,n,
TR. SO
EAST 1 T.
/
.
.
M it
wsaT a*s.d
f
BEAST i3O.d
.
rm. -1
A
WEST !
y-
M 34
AST 1:.0'
TR. t! 1
60' I
t 6.0'
/
EAST 110.0'
/m
/WEST
11"
rR 32 f
AST 104A
to. Yo
E T 90.0'
_
'
sa.o'/ '1 /
COUNTY /
PROGRAM /
LOCATION
REPORTED BY
SERVICE REQUESTED
ACTION
COLORADO DEPARTMENT OF HEALTH
REQUEn
OR SERVI E
CE I VED BY -��1 L DATE
ADDRESS
TE LE PHO NE
r
ACTION BY
SH -M-71 (4-71-50)