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GARFIELD COUNTY BUI4DING AND SANITATION DEPARTMENT Permit N. Z 2 5 a ,I
t I - 109 8th Street Suite 303 Assessor's Parcel No.
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t Glenwood Springs, Colorado 81801 it.
9 Phone (303) 945-8212
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This does not constitute
'F t INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. T
f ,' PROPERTY / �� / � I / n M /1Tn y11 n /
a 1 O wner's Name 1 " t • 6 (A l R e ) P r l i ( � e 'Present Address "' (2/ V 1 te r r & �p hone Sang i t `
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fi /rte / !/1 ^A ,Q Rd kit p /
1 System Location l.4/T� 9 31 on 6R✓JS,S Me.cq /�d - ki �e C0 6 /bS6
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e i Legal Description of Assessor's Parcel No. - -- -- *+
e; LEAC _ rtAE z 7.1 UN 17S wITHG, ,:,
+ SYSTEM DESIGN _ 1 8 I/
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I Septic Tank Capacity (gallon) Other I '
/18 3 Percolation Rate (minutes /inch) Number of Bedrooms (or other) .r a,
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2 1 Required Absorption Area - See Attached ,
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44 Special Setback Requirements: yy
— , ,ti Date 1f t CI i, y; )4 ( G
Inspector A c(- � .
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r . FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)
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( '' Call for Inspection (24 hours notice) Before Covering Installation g;
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System Installer . 4 CQY.1 S c
( Septic Tank Capacity / 000 r -r,4--'- -' - - - --
k Septic Tank Manufacturer or Trade Name 0 - -
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( i Septic Tank Access within 8" of surface
��jj �//11 Nn ��(/ P A S Absorption Area 2. / . 15 2 'B Q't 4� 7` l r ? r ✓ r ' r
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I '. Absorption Area Type and /or Manufacturer or Trade Name ), 77 . 7 — A Are)
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e Adequate compliance with County and State regulations/requirements /�•"'. , i
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I Other (�J i' l�/� G a
a Date j _ a r e .. 4 nspector /A 7 �� i' / 4 4 !'C Cr � .. .� % e
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RE N WITH RECEIPT RECORDS AT CONSTRUCTION SITE
; •CONDITIONS: 1 )
p 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. + e
�;. 2. This permit Is valid oply for connection to structures which have fully complied with County zoning and building requirements. Con- t
l' nection to or use With any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a , t
a 4 requirement Of the permit and cause for both legal action and revocation of the permit.
i r 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material ,,
I ` variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense (5500.00 fine — 8 1 •
1
. e months In jail or both). `p
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White-APPLICANT VNlow - DEPARTMENT