HomeMy WebLinkAboutOWTS Design Specs.ARF' ELD
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r*îol rå?li :,äi :i[':f, , o N D E pARrM E Nr
clcnr¡¡ood springs, c"rt'ul.,'aìonr Permii 4* 7f
Phone (g7t)g45-8212 Assessor's Parcel No'
INDIVIDUAL SEWAGE DISPOSAL PERl\¡IT This does not consiíiuie
a buildi or use permii.
PROPERTY
Ov./ner's Name
System Location
Legal Descripiion of Assessor's Parcel No
SYSTEM DESIGN
Septic Tank CaPacitY (gallon
Pei-colation Raie (minuies/in
Required Absorption Area - See Attached
S pecial Seiback Requirements:
Daie
i Oiher
ch) Number oí Bedrooms (or other) 5
s/sø/4fa EÉ /í/{/G*4*EE<EV
s/ry "- presenrAdd,.=, z?{cÉ. -v/ pnonuÉ!z*72t7/¡g
z/a
lnspector
c P (as installed)IN
Gallfor lnsPection (24
SYs'rem lnstaller
hou rs notice) Before Covering lnstallaLion
Sepiic Tank CaPacitY
Sepiic Tank Manufaciurer or Trade Name
Septic Tank Access v¡ithin B" of surÍace
Absorption Area
Absorption A.rea Type and/or Manufacturer or Trade Name
Adeq uaie compl i a nce rniih County and Staie regulations/requirements
Oiher
Date lnspecior
RETAINWITHREGEIPTRECORDSATCONSTRUCTIONSITE
CONDITIONS:
1 . Ail instailatjon rnust compry wiih afr requirements of th^Jororado state Board of Hearih rndividuar sewage
Disposalsystems chapiei25, Article 10 c'R's' 1973' Revised 1984'
2. This permit is valid only for connection to siructures which have fully complied wiih couniy zoning and
building requiremenis. connection to or use u¡ith any dwelling or struciures not approved by the Building and
Zoning office shall automatically be a violation or a requirement of the permit and cause for both legaf action
and revocation of the Permit'
3. Any person who constructs, alters, or installs an individual sewage disposal systern in a manner which
involves a knowing and materíal variaiíon from the terms or specifications coniained in the application of
perm,it commiis " ılu=. 1, petty ofiense ($500.00 fine - 6 months in jail or both)'
White -APPLÍCANT Yellov¡ - DEPARTMENT