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HomeMy WebLinkAboutpitkin.eh.272929303027 (1978)t ^� PERMIT N BER .40Owner I%V Owner's Mailing Address PITKIN COUNTY HEALTH DEPARTMENT RECEIPT NUMBER© / 3 -da -7 Contractor C�yxlc,_ _ Phone No. Address System's Contractor's Name_04641ele— Address Legal Description Lot Size Number of Bedrooms Owner's Signature — PLOT PLAN: ATTACHED AS REQUIRED Type of Building by Use Type of Water Supply S,080/ yt s/"/ A /_ C— Date Type of Individual Sewage Disposal System� ,/'/N11X- —,e-7����'%Z� 12��� Type of Soil or Soil Classification /�Om To `sx/j°QJ Proximal Location of Bedrock 72/ Proximal Location of Ground Water Table Percolation Test Date �U Minutes Per Inch — Minimum Recommended Absorption System Size Minimum Recommended Tank Size Special Conditions of Issue: NOTICE p 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 forsuch chan S. Approved for Issuance By Date FINAL INSPECTION APPROVAL t Date (Drawing of System on Back) WoeagoP Amo Gam �Oc.1N Oi{T I D/J -roe +J 27' I I -TO (GA-u.o A1 o PC LA J o 0.0k1Ca�S6Pit e. 'T�►A1K- 65' D I s -rel omT Gov 2S. ISI 0OC C- 35,4H 0 - Tb-m-r,oN t>F L -o -r F -S i A O -A iJ r,�t rY rr Dr, A,NAr.E t �{'r N tt N a�i`oo'opE _ _ 1 -� ' f F ACCESS S tv ANT ��5 {U-ri I-ry ANO �RAtnA:E � �A5EtVrENT t , 25:�rLC. SND ,4L ERSE.MENT'. � - '74 86' T jr r O, Q RT CUT FOROJN UATt Ord :�F ? +6F �Viti77NG b ' 1 i s I `�� y W 10 UT+L-tTY -' T)R.+L,NAGE 'EA EMS;NT E:-`- TfklVC-AY WEST 15.'1:. 1S' W. C. *.IVO.-,rrjyT+, .NtTN /;L'Vf'vt{P.Sl''li l_AF' NiA'RiGir% LS 10332 PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test �1 PROPERTY OWNER PHONE KAAII IIU(_ AnnRFQC Three (3) test holes required per system Test Hole Depths (24" minimum) Diameter of Test Holes Water remaining after 8 hour soak C TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3 3 � � Drop Time Drop a I Time 43(- Drop Time 2 St -21 7Z. j ryj / CI Q I Percolation Rate Each Hole" Average Rate Comments on soil or ite: 7 I Signature .................. M