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• 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 2 4 3 t
' y i _ 109 8th Street Suite 303 Assessor's Parcel No. , I,
k Glenwood Springs, Colorado 81601 ( e
e +, Phone (303) 945-8212
• & This does not constitute , r
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INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 1
°r PROPERTY i \) �I�
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r Owner's Nam n hQ f K- Present Address O J ..� a v "a � Phone " ( ( I f 9
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' r System Lo cation an J5 elm SS "` �f �A ' , ,
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t Legal Description of Assessor's Parcel No , i ,
• SYSTEM DESIGN ½9t7flStI
//SI - a°,/ �l'¢d 33 J
7 n Septic Tank Capacity (gallon) Other ."
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t / M PdrZ'olation Rate (minutes/inch) Number of Bedrooms (or other) t <i
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: Required Absorption Area - See Attached
Special Setback Requirements: • '
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h Date & — j .. f Inspector —I a tfZ�— q y
i FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 `Y
'• ? Call for Inspection (24 hours notice) Before C overing Installation
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', e System Installer 0 1t/ 1•1 e A - - -, -- r r
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q ? Septic Tank Capacity - - - - - -- F
Septic Tank Manufacturer or Trade Name
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Septic Tank Access within 8 of surface r, '
Ab Area S I._ CAC II— C'I -1AM OE,.1 3 _ N 3 7 a.&,e pc : "
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Absorption Area Type and /or M anu f ac t urer or T ra de N ame 1 K I' ! 1 - � _V2 i d n S }
i. Adequate compliance with County and State regulations/requirements eI— n i
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• Other N C C D S 0 L e A A/_ O V � 7 3 '
Date 1 /— 3- 9 9 p A !`' ° °.
it , Ins ect
' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE . ' t
' 4 •CONDITIONS: 1
1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter (;
25, Article 10 C.R.S. 1973, Revised 1984.
t,1 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- I j
± nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a {
requirement of the permit and cause for both legal action and revocation of the permit. 1
}'', 3. Any person who constructs, alters, or installs an individual sewage disposal system in a man�rer which involves a knowing and material •;
' ' variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 f ine — 8 ,, i
i i! months In )all or both).
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` . % White - APPLICANT Yellow - DEPARTMENT
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