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Thter relit:Lion Jontrol Division
)1flG .;1st 12th, venue
iianver, „7.oiorado 80220
ALPLICAl'ION FOR AsPRO✓AL OF' LOCATION FOI szt ?IC TANK SYSTEMS
THIS IS NOT A n
Alriia =ant (Owner): = .: 3R U NQ S
8 966 f *
Mail Address: Cit yr Nv�.! �as�Zf l Na � /e0 fleyP
r
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEWS
Attach separate sheets or report showing entire area with ;aspect to surround -
ing areas, topography of area, habitable buildings, location of potable water
wells, soil percolation test holes, soil profiles in test holes. a /�
1. Location of Facility: County GAn '' ( /It City or Town : 4,,/
Legal Description Lot Size: / - ' R vs
Tape of area and facility - Number of persons served:
subdivision rr 'Motel , Restaurant Trailer Court
Other: fl A N C n +�
3. Source of domestic water: Public (name):
Private: Well X Depth Other Depth to first ground water. table •
4. Is facility within boundaries of City Sanitation Districts
If so name: —
• 5. Distance to nearest sewer systems
..Rave negotiations been attempted with owner to connects
• t
If rejected, give reason:
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours:
7. Name, address and telephone of person who made soil absorption tests:
Sr / F •
8. Name address and telephone of person responsible for design of -the systems
•
9. Est. hid opening date: Est. Completion :a -s Est. Project Costs
Date: 5 7 6 /73 „ , ;v ` '_
_t'• ure o s ne
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