HomeMy WebLinkAboutpitkin.eh.273503300030 (1973)PITKIN COUNTY HEALTH DEPARTMENT 0753-00-690
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PERMIT NUMBER 7 20 07 / 0RECEIPT NUMBER 1&106
Owner Phone
Address & x ',/ S 16"'51/
Contractory�"k ���� E Phone
Address
Location of systemA�Plkla Zr�
Legal description
Date
Siganture of owner
Percolation test data '� O minutes per inch
Minimum recommended absorption system size
Minimum recommended tank size
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Permit application valid one year from date: Application to become permit and
final only after lower portion i m eted and signed. Retain this form at
the construction site. i
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COLORADO DEPARTMENT OF HEALTH
COUNTY REQUEST FOR SERVICE
PROGRAM o� —RECEIVED �'—
/ BY —DATE /&/ /�7
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LOCATI ON�1 bo �` �/� NAME Api-j", V
REPORTED BY ��1 f G G► �� ADDRESS TELEPHONE
SERVICE REQUESTED
ACTION BY
SH -M-71 (4-71-50)
DISPOSITION
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