HomeMy WebLinkAboutpitkin.eh.264929102038 (1975)bJ7
720C13 � PITKIN COUNTY HEALTH DEPARTMENTCl
PERMIT NUMBER RECEIPT NUMBER I / L1
Owner 3 4,1�1A Phone # 3 3�
Owner's Mailing Address 1J `�-
Contractor �� (13 � l� Phone #
Address
Systems Contractor's Name a—,`
Address ��---� - C�j J
Legal Description L 6 � J � ��� � s i
Lot Size �� �� c -K Type of Building by Uses/ <1
Number of Bedrooms 3 Type of Water Supply -e
Type of Individual Sewage DisposalSystem
c�
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Ground Water
Owner's Signature
el
Detsjn'EAi� ,� l
rLUT rLFUI: /Je�Wt /
t ctGL r l r l f7U l -
t T
a7 O- c C- cJ P < c
0—t � --'zcy r CyC 4 r r � �,- 2,$.
Percolation Test Data v / Minutes per inch
Minimum Recommended Absorption System Size
Min' um Recommended Tank Size (��Ca / / 0 s
?�r i
e i application valid one year from Date. Application to become permit axl# final only
after lower portion is completed and signed by the Sar ri ; RETAIN TFORM AT HE
CONSTRUCITON SITE, �l )) //�% /1 /) • / J
Date -V 7 Sanitarian
a
i
ITKIN COUNTY ENVIRONMENTAL HEALTH
(Field Test Data Sheet on Percolation Test
PPnprumv nWNPR
PHONE
Percolation Rate Each Hole
Average Rate lnCh
Comments on soil or site: 4C
a c k �---
STCi1A'i'UIiI. DATE y
C
C,'b-A,&rX1
MAILING ADDRESS ����)3
/
LEGAL DESCRIPTION OF PROPERTY
(
S
LOCATION OF TEST HOLES
�9
Three (3) test holes required per
Test Hole Depths (24" minimum)
system
_ Diameter of Test Holes
�rz�
Water Remaining after 24 hour soak
�I
TEST HOLE #1
TEST HOLE
#2
TEST HOLE #3
DropTime Dr
Time
Qrop
Time
.'G°n
5 ( 2-111 c
Percolation Rate Each Hole
Average Rate lnCh
Comments on soil or site: 4C
a c k �---
STCi1A'i'UIiI. DATE y
C