HomeMy WebLinkAboutpitkin.eh.264929102043 (1975)9 �� � � L�PITKIN COUNTY HEALTH DEPARTMENT ' 9�
PERMIT NUMBER I/ RECEIPT NUMBER lU
Owner
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Owner's Mailing Address
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Address
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Systems Contractor's Name �j d �� W ed
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Address
LDescri tion
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Lot Size �2 Type of Building by Use
Number of Bedrooms _ Type of Water Supply (,C/ e!
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
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Proximal Location of Bedrock '!
Proximal Location
Owner's Signature
PLOT PLAN:
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Percolation Test Data t/ O Minutes per inch
Minimum Recommended Absorption System Size
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Mi Recommended Tank Size (/"
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Pdrdit application valid one year from Date. Application to become permit and final only
after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE
CONSTRUCITON SITE.
Date Sanitarian
(Drawing of system on back)