HomeMy WebLinkAboutpitkin.eh.272929201062 (1978)PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER�-! / / RECEIPT NUMBER 2-7602— ZS
Owner �i4 Y ��T1 �l LL I f��►
�tT Phone No.
Owner's Mailing Address C SLC -S �-)C- 4C_ QL' Z coUCVj
Contractor �� `- `��� Phone No. 3+46
Address V _rE
System's Contractor's Name
Address
e;)'Y,6 " -,_
Legal Description L-cD-T
Lot Size /(�) AC Type of Building by Use �,c i�C ti �1 �L---
Number of Bedrooms �� ��� Type of Water Supply E i7S �E v�%t� Eta
Owner's Signature Date c �
PLOT PLAN: ATTAC4ED A� REQUIRED
Type of Individual Sewage Disposal System __)E_PT/L' //9AlK' Ei�/1GE 6JE/
Type of Soil or Soil Classification//AZ Z
_ C 4XI / TD Sri 7—
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Proximal Location of
Proximal Location of
Percolation Test Date
Minimum Recommended Absorption System Size 41200 &o
Minimum Recommended Tank Size 420
Special Conditions of Issue: NOTICE
Syd When properly signed for issuance, this application MUsr ec 1NS7--1L-LE,0 � 1 becomes your permit. Application valid one year from
7/ye-
date. If an individual sewage disposal permit Is issued
for property on which no building permit has been
2 Q 57 19Z'issued, the individual sewage disposal permit shall
j expire 120 days after its issuance If construction has
�ETu�EE� ff�y PQ�jt/� L7F �� Q� _1/�LQ -1110 not been commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
vfllvlolilt! 1 e �r9T ' t the permit, unless approval is secured from the Health
Officer for such ch nges.
Approved for Issuance By Date
71
FINAL INSPECTION APPROVAL- Date
(Drawing of System on Back)
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