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X GARFIEa,u cOUrrr• Lanni:JR /i.1NTAL
2. )4 Br,t3OE Ay},
G.:AmooD SPRINGS, COL.ORizL■)
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
.yf_ RECEIPT 43 a _/7
(6 , 6 77/)
OWNER :A 423,4 o'aaadc'sctAv___ ADDRE =SS: /kd '.. id en4weze„ _. PHONE
CONTRACTOR:,I , ,', P1 r L. „ „, ADDRF.SSW /// e n y e L PHONES .UP7,3
SITE LOCATION: i.e / ' , _ __ tn., OF BEDROOMS:3 SIZE OF LOT:
9
Application for an individual sewage disposal permit is hereby submitted., The
individual sewage disposal system will be constructed in accordance with the
regulations concerning individual sewage disposal systems within Garfield County.,
This application is valid for six (6) months from date -ign -•
DATE :1 � o d 7 /9pr SIGNATURE: 4 �
� / /
Percu.ation test results: per inch:_
Recommended minimum size of leaching system: --
Reconum nded minimtun size of tank;
PLOT PLAN
DATE: SANITARIAN: