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HomeMy WebLinkAboutpitkin.eh.273503200013 (1974)©-o3z-oo-at3 �20290, PITKIN COUNTY HEALTH DEPARTMENT 0 � � PERMIT NUMBER RECEIPT NUMBER &Pb Owner C !'YLt�Q� 41 h- �"/�1r5 Phone # Owner's Mailing Address Contractor Phone # Address Systems Contractor's Name Address Legal Description Lot Size �-a e�er �.s �91��1 z fes/ Type of Building by Use ��'i14 Number of Bedrooms .� Type of Water Supply Type of Individual Sewage Disposal System ��r1C'r 16f+K o Sff- PAC� D Type of Soil or Soil Classification�,% /V-0 / l �� I Proximal Location of Bedrock &% Proximal Location of Ground Water Table Ae7- Owner's Signature PLOT PLAN: Date Percolation Test Data Minutes per inch 3� FA Minimum Recommended Absorption System Size Mini um R coom�manended Tank Size > -1 ��lication valid one year fr m Date. Application to beco e permit and final only Pe it app after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE CONSTRUCITON SITE. Date Sanitarian (Dr wing of system on back) COUNTY 5-7 PROGRAM / Z LOC ATION-Z�Z, e Je REPORTED BY 16 SERVICE REQUESTE A 4 ®COLORADO DEPARTMENT OF HEALTH REQUEST FO SERVICE RECE I'VE /B' ADDRESS 0 DATE A / TELEPHONE DATE lo/ SH -M -7t (4-71-50 COUNTY COLORADO DEPARTMENT OF �'---.--�-�--� � HEALTH PROGRAM REQUEST FOR SERVICE RECEIVED By LOCATION REPORT�EB NAME c --_ADDRESS SERVICE REQUESTED 1 ACTION RE T ACTION By Z SH -M-71 (4_71_50) ISPOSI TION �7 �Df9TE -______TE LE Ph'O NE DA TE OOLORADO DEPARTMENT OF HEALTH -OUNTY L� REQUEST FOR SERVICE G 'ROGRAM j RECEIVED BY�pJL/J DATE 7 _OCATION NAME Z j�,5 2E PORTED BY ADDRESS TELEPHONE ;ERV I CE REQUESTED 742 » ACTION REPORT ,CTION BY , �s j l��./ DISPOSITION DATE] j 3H -M -7i (4-71-50)