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HomeMy WebLinkAboutpitkin.eh.273503200018 (1977)PITKIN COUNTY HEALTH DEPARTMENT PFRMIT NIIMRFR / RECEIPT NUMBER Owner ur.1 `�1`�t'"`s� Phone No. �i 2 �' Z� Z !p Owner's Mailing Address es ) ;s - Contractor Contractor D- L,3 ,-,� Phone No. Address x i LI J I System's Contractor's Name 3o,,,.s_ s- — (;E(2 BAZ -+- SM Ai+ --S Address Legal Description L L-1 Lot Size Type of Building by Use Number of Bedrooms 3 Type of Water Supply Lk) QAk Owner's Signature `�� Date 1 S A �C'�- PLOT PLAN: ATTACHED AS REQUIRED Type of Individual Sewage Disposal System ��%�' 1A1VIe Type of Soil or Soil Classification ,!�WOY 4y ZZWAZ % e1_'l,4y Proximal Location of Bedrock / 1VO7- E>FT 1A(A/Q0 Proximal Location of Ground Water Table �L7% Percolation Test Date .21_ Minute Per Inch _11/20/72 Minimum Recommended Absorption System Size fT Minimum Recommended Tank Size AO CAA L Opt/!' r �«O ,07/,M67AIT S NOTICE Special Conditions of Issue: when properly signed for issuance, this application ')����� "t v //�/j V's 7 B� O f ,e becomes your permit. Application valid one year from /1 CsC j/ 0 `, �— ✓^ data. If an individual sewage disposal permit is issued Ma�] J , /1 �n� 1 A,� �['� /®/'1� ��©M�[�, for property on which no building permit has been 1 I l �"1 V f" r 0 �� �� issued, the individual sewage disposal permit shall ,q�n 0 A / �j /1 P/1� ; /p� expire 120 days after its issuance if construction has [� /�/ L�7 C not been commenced. Any change in plans or speci- fications V ��{ ^ , IATEO /� S '1C QMMO ,) AR -CF -A. !1 eperafter the permit has been issued invalidates <J (3-/�% l/ �! /'�i �1 /l the permit, unless approval is secured from the Health Officer for such changes. Approved for Issuance By i Date _5 /,V//= 5 7 FINAL INSPECTION APPROVAL Date (Drawing of System on Back) )R\/EY OR Tuffs L10,4C COMMON AREA moo Ho lig 4:7, \ ��QO F O l e-ATICA, IN, DfQj�J, [RU; SCALE I TRACEO `ROM i:?LiCJ OF 5y TZt-CO Ilz ";-13 PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER P160,61 s"�`�-- PHONE MAILING ADDRESS LEGAL DESCRIPTION OF PROPERTY LOCATION OF TEST HOLES OAJ C 4ql/ OA A)e6� Three (3) test holes required per system Test Hole Depths (24" minimum) Diameter of Test Holes Water remaining after 24 hour soak TEST HOLE o.1 TEST HOLE No. 2 TEST HOLE No. 3 Drop Time Drop Time Drop Time 3 '11-1�. / �► . t "I— of g 2 Percolation Rate Each Hole Average Rate Comments on soil or site: Signature Date zo a/