HomeMy WebLinkAboutSystem Design SpecsGlenwood SPrings, Colorado 81601
Phone (g7O) 945-8212 ;::i:",,, #,7.1:*(
INÐIVIÐUAL SEWAGE D¡SPOSAL PERM¡T
pROPERTY
owner,s N^ "T/laørq: hÃßãAApresenrAdd ru"'9aã czrrÞyi à¿Ã/ Phone 773* o? z Z
This does not constiiuie
a buílding or use permit.
svstem Locarion 5Ã.4 IL
Legal Descripiion of Assessor's ParcelNo
SYSTEM DESIGN
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Required Absorption Area - See Attached
Specíal Setback Requirements:
Date .4)*,/g-/7 lnsPector
FTNAL SYSTEM INSFEGTION AND APPROVAL (as installed)
Gall for Inspection (24 hours notice) Before covering lnstallaiion
,s-6
-/ ¿r-J2L./ J (Z SepLiu Tank CaPacítY (gaflon)Other
7-- Z Percolaiion Raie (minuies/ínch)Number oí Bedrooms (or other)
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tz ¿Ldl/--Y eF æ-4 atr,+/ s6s
System Installer
Sepiic Tank CaPacíiY /z{e
Septic Tank f\4anufacturer or Trade Name
Sepiíc Tank Access, within 8" of surface S
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate complíance with county and state regulaiions/requirements
s
Other
Date l- e no nfnr
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
CONÐITIONS:
1. All installation must comply wíih atl requírements of the Colorado State Board of Health lndividual Sewage
Disposal systems chapter 25, Article 't0 c.R.s. 1973, Revísed 1984-
2. This pennit is valid only for connection to structures whÍch have fuffy complíed wíth County zoníng and
building requiremenis. Connectíon to or use with any dwelling or structures not approved by the Building and
Zoning ofäce shalt automatically be a violatíon or a requiremeni of the permít and cause for boih legal actíon
and revocation of the Permít'
3. Any person who constructs, alters, or installs an indivídual sewage dísposal system in a manner which
involves a knowíng and materíalvaríatíon from the terms or specifications contaíned in the applícation of
permit commits a Class 1, Petty Offense ($500.00 fine - 6 months in jaíl or both)-
White - APPLICANT Yellow - DEPARTMENT
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