HomeMy WebLinkAboutpitkin.eh.272929201037 (1978)t
r ,,PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER `� RECEIPT NUMBER `�7
_/
Owner I
Owner's Mailing Address
Contractor
Address
System's Contractor's Name
Address
Phone No. 2v2- - — / i -3 2
Phone No,
'/
Legal Description '�
f_
Lot Size �� 1 x /cJy Type of Building by Use
Number of Bedrooms 3 " `/ Type of Water Supply
Owner's Signature , 0 Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock
Proximal Location of Ground Water Table
Percolation Test Date
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
Special Conditions of Issue:
Approved for Issuance By
FINAL INSPECTION APPROVAL
(Drawing of System on Back)
Minutes Per Inch
Date
Date
NOTICE
When properly signed for issuance, this application
becomes your permit. Application valid one year from
date. If an individual sewage disposal permit Is issued
for property on which no building permit has been
issued, the individual sewage disposal permit shall
expire 120 days after its issuance if construction has
not been commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
the permit, unless approval is secured from the Health
Officer for such changes.