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ASPEN06PITKIN
ENVIRONMENTAL HEALTH DIEPA TMENT
�I':D1i1D IAI. SEWAGE DISPOSAL PER11IT NO.
TYPE OF PERMIT:
Initial Construction ( )Er+crgency Use ( )Repair work,(Piievioua Permit f .) f )Alteration of an existins system,
It installation (Previous Permit 1 )
( )Use Permit as a zeaule oC Said ( )others97
f �I
ISSUED TO: _ DATE OF ISSUE •.
Owncrl�OiiC- I aII' I � /�W J
Aw&'me Phone Business Phone IV: -3261_
Mail ing V T ��
Ad7ress
Phone
Moa i.i. ng
Address SAMCE
Sews e Disposal System Work to be performed by
This permit valid anly ffo�rpres+iscs location Ly the following .ldegga: deucription
LOT SIZE. LAJe`, MATER SUPPLY f 9j #J `, ,
This Individual Seg:.yc Disposal Permit is granted with regard to the following usew6a�/�L ✓!V(�I�Vf*ril 7lV�I(.tI4
/� �y _ 0 Dishwashers ® Clothes Wa3hors 0
Nutaxz oft Dodreoms Lo[ts i/ Garbage Dis/posals
CALCULATi.D AVER;.CE DAILY WASTE LOAD /� GALLONS. `-2 felt5oAS al
THE NATU E OF THE 5ISTE'." ! CLLDED M"TDER THIS PEIL'-1IT:
Ty.2 >f Tank or Treatment Unita SE -P sc, / Tank Capacity 1 v _Galion inin a
111:1.2rw thcd of Final Disposals A8s,'QQ�1-0A Abaorptioa Area Q Square Fee! Minimum
. De.cription (including -brand name, if any) of other equipment or appurtnarcest
1` Iq OAJe,
i, -.Other conditions or Spccificationst
d,t441 j
STACES REQUIRING INSPECTION BY THE HEALTiI DEPART.IENT:
i )Before Exca-ation ( )Upon completion of excavation and prior to phn,ement of gravel ( )Before covering uistritrution
system of absorption :i.nid
Prior is backfill of .any component ( )Other, S)ccifyi
Plans ami specifications of the p:oposcd sewane disposal system have boon cuviewod andare ecnsidered satisfactory. Prrmi'SaSon
ii hereby granted r+, tho oyer or his )cent to perlorm the Mork Indicated above in accordance wish thr. :Itkin Cocnt; ln,ltviduai
Seva•;e• Disposal Rrn:latior.s in effcc_ on the date of issue.:n ac'( Itlon to qen l pcavtsiona set forth on the revc;se herecr,
this Permit is su``)cct to the follcainq addlticnal terms and conditions:
APPROVED FOR ISSU}E BY
The ahnve in.(ividu.el acuago di3posd1 system in3talled by �Jtiw/Y rt ,
Ms txcn lr.:+pc+_tcd l,r use ry a rcprcycnt.Ittve of the Aspen/lIke.kiin Cr.tii[ena.r+ta H.^a th D<:p.�rtr.ent. Th. ovnur al'•:u 0- aim
respuns_oili,C in C,1312 of tallurc o: inadequacy o th s •rCw•H14 dispo4al Wystem. Complete as -built drawing attaznud.
DATE'Of JINAL INSFECTION1
DY; • TITLE
130 South Galena Street Aspen, Colorado 91611 03/925-2020
ASPEN*PITKIN .
ENVIRONMENTAL HEALTH . DEPARTMENT
"PLICATIONFOR AN INDIVIDUAL SEWACIE DISPOSAL- PEI:U MIT
Mame of CW'NER 0. �J�S'; h c��
PHONE -7- 3L 9
Address of CWNErc (-)C7� ►-f � � �• A • ���;,. � —.�._� ��.
Name of APPLIC:'u�:T � c-��c Gi� � �� C`1�5 c �'HCNE 9c�7'
PEPM!T TD BZ: (.'Picked Up { iM.aiLed too TYPE OF PERMIT: 4i0ew Installation ( )Repair
)Applicant j )Emergency use ( )Alteration NO•" due to failure
U)CA?ION CF PrO?OSED SYSTEM! �/
Irgal Description ���v H{ �1 C� ! N T � / V ''� [T� J C N I
Vet Block filing Subdivision Size of :Lot acres
TYPE OF STRUCTUME: ( )Single Family Dwelling t )Otters M Com. G",s �r� ,Do You plan any fcradditions to the
residence? ( )YES (—S'S�O
so. of bedrooms no. of Lofts No. of Carbace Lisposals S� No. of Automatic Dishwashers tai
Yo. of Autonatic Clothes washers
WATER SUPPLY:( !Privat,s well, Depth Or ( )Publie, Name of System
( )Stream or Croek
SYPZS OF INCIVIOUAL SEwAnr DISPOSAL SYSTEM PRO?OSFDt
itsseptic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting toilet ( ))Others
Incineration Toilet ( )Y.ound
(')Recycling, potable use ( )ttecycllnq, other use ( )Vault Privy ( )Otherhers
The :nitial site .n:pectten must be arzangcd with the Aapen/Pitkin Environmental Health Depart..ment (925-202C, 8:20-9:20 a.m.)
2eto[c a permit ren to isa:cd. Tho individual sewage disposal permit must be issue) before a building permit can be ;:btcined.
71NAL :NSPZCT:Cy APFAO.:AL ?LUST 3E CIVLN BY THE ASPE4, PITXIN ENVIRONMZNTAL HEALTH DEPARTMENT PRIOR TJ UACXFIL_:NC ANY PORTION
nF THE SSf�TE.Y.
Application for an individc:al sewage discosel permit is hereby submitted. The undersigned acknowledges that the above information
is true and that t.'se n dation will invalid,te the application and any subsequent pernit. v
Signature of Appli^.ant�7 t f��r,., CG_ _ ,ATL,
('this application becomes. invalid 1. months fzom the above date.)
VOTE: PLOT PLAN must be filed with this application.
Please locate the fallowing iteas by measured distances:
1. Property lines and dimensions.
2. proposed and existing water wells on subject property and
adjacent property.
3. Domestic water service lines.
4. proposed and existing buildings, driveways, and other
strubtures.
S. Strear..s, laces, ponds, irrigation ditches, and other water
courses.
`. 7roposed and existing individual sewage systems on subject
property. ,
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
Tho under he eb acknowledges receipt d ual sewage disposal per -sit application and a permi• a e,in the amor:r.t
OE __=, Receipt Number , Date Fee Received �� .by �L=�-------
Aeusinis(trativo Ofiiccr
•�-u%�.3
130 South . Galena Street Aspen, Colorado 81611 383/925-2020
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