HomeMy WebLinkAboutSystem Design Specs - PlansINDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name
This does not con stituie
a building or use Permii.
non*ØF-r?/ 3
108 t¡ghtn Streer' ùurre 'iu I
Glenwood SPrings, Colorado 81601
Phone (970) 945-8212
Presutrt Address
Permit -17 4/
Assessor's Parcel No-
Sysiem Location
Legal Descripfion of Assessor's Parcel No'
SYSTEM DESIGN
'- -{n) sePtìc Tank caPacitY
fr az
Other(gallon)
(as installed)
Callfor lnspection 1Z+ hours notice) Before Covering lnstallation
ZZ Percolation Raie (minuies/inch)
Requíred Absorption Area - see Attacheo þ/ 3
Special Seiback Requiret r rents 73-r
Date lnspector
System lnstaller L
Sepiic Tank CaPacitY
Septic Tank Manufacturer or Trade Name
Sepiic Tank Access wiihin B" of surface
.P Rb=orPtion Area
Absorption Area Type andlor Manufacturer orTrade Name
Adequate compliance with County and State regulations/requirements
Other
Date lnspecior
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SIÏE
CONDITIONS: ---r^ ^r *ha r-nrnr¡rrn srate Board of Health lndividual Sewage
l.AllinstallaiionmustcomplywithallrequíremenisoTlheColoradoStateBoard
Disposalsy'tem' cnapiei 25' Article '10 C'R'S' 1973' Revised 1984'
2. This permit is varid onry for "onnu"iion
to structures which have futy compried with county zoning and
building requirements. connectio;;; ",.
use with any dwelling or structures not approved by the Building and
Zoning office sharl automaticary be a vioration or a requirement of ihe permit and cause for both regar action
. i:i rr-u',.,iïH:*"*ffiHl"iri*,
or insiarrs an individuar sewage disposar svstem in a manner which
involvesaknowinEandmaieríalvariationfromthetermsorspecificationscontainedintheapplicationof
permit "o**i,u " ðlu=, 1, Peity off"ns" ($500.00 fine - 6 months ín jail or both)'
P .? a"t Vt
Whäe -APPLICANT Yellow - DEPARTIVIENT
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