HomeMy WebLinkAboutpitkin.eh.264929101001 (1991)C
REQUEST FGR FFiT M AND SWMC SYSTEM DEPEMON
USE PEdUT APPLICATION
Date Requested Check/Receipt Number
Bill To rl i.L)i0 0 � n . � �`� � � - �.� �, r � ks; u C)cd
T YL Y
Inspection Requested By LL: _& ',-LVCc -
Original Report To Be Sent ToT
Copy Of Report To Be Sent Tod .n -
Property Owner
Parcel ID Number of (a LN -
Legal 1/4, 1/4,
Loth_, Block i Fili
Address U `3 i �i , o r c N
Building Occupied
Date Septic Tank Last PuME
r `y n
Sec. , T S,
Subdivision-
-
ubdivision_
r-ni'D4 —
=4
Age Of Build
# Bedrooms__
DEPAR4MMP RHO(MS•
Permit Number"ZDry
ear Issued ��� No Records Found
Septic Tank Capaci(Gallons) Septic Tank Mat _dal
Leach Field SizeSq. Ft.) Leach Field Type__-
IlaS ?ECTION:
Date Of InspectionInspector�
Soil Conditions: aturatedow vered Other
Septic System: Functioning Satisfactorily Not Functioning
Camrrents: , P 1 -- s—
Water Supply: Public: Name C) -
Private: Well , Spring , Cistern , Surface ,
Other _
Well Construction And Location: Approved
Unapproved Because
Bacteriological Water Test: Lab Number Date
Acceptable
Other
COMMENTS-
A.P.E.H.D.:4/87
8blla,