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pitkin.eh.273503200021 (1973)
Owner LAY Address p© PITKIN COUNTY HEALTH DEPARTMENT PERMIT NUMBER i'J 2 01 n ,` I'd V & rw " Si -,c - IN RECEIPT NUMBER 3 Phone # �z3r 3 Contractor Phone # Address Location of system N& Lot size 61eA S�acJ� Legal description Number of bedrooms DateY 73 Signature of ownerxl//�/�/�G� Percolation test data minutes per inch M -i -minimum recommended absorption Minimum recommended tank size Permit application valid one year rrom nate. Application to oecome permit ana iinai only after lower portion is completed and signed. Retain this form at the construction site. Date l� -4f - 71 DRAWING OF SYSTEM +�6V Sanitarian .a�j