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. } V GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit n - 3 3 1 � r
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1 109 8th Street Suite 303 Assessor's Parcel No. r
Glenwood Springs, Colorado 81601
11, Phone (303) 945 -8212
S r • This does not constitute
2 INDIVIDUAL SEWAGE DISPOSAL PERMIT /J J �� /C C I a building 6r use permit. tt 1 "
f s' PROPERTY ( i' t��-J_ 1 V - i =
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r. Owner's Name , Present Address I) W
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4 �{ System Location - - Ica . ' I ' I ,
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! Legal Description of Assessor's Parcel No. - " ( T'
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, ! SYSTEM DESIGN (6 A C -i c A �^ rSG^ OG D 64 2 57 _ 3 tt P1 CC t5',
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e Septic Tank Capacity (gallon) Other �L
t 1 11 2 Percolation Rate (minutes/inch) Number of Bedrooms (or other) J ) •
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Required Absorption Area - See Attached <.
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Special Setback Requirements: / •
+ Date 7 - 'L C I -O O - /� Inspector it t-f (< f ,.
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} FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ;
{ ' Call for Inspection (24 hours notice) Before Covering Installation ..
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1 System Installer Ciariiik
r i Septic Tank Capacity fa 6*.
■ d Septic Tank Manufacturer or Trade Name _ : w
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( f Septic Tank Access within 8" of surface _ YF5 i
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t r Absorption Area /Z 2 C O Q 6 r x g J adicWW C/m3/$tJ _ /.1 77f�26er /neski €-Ci )
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� Absorption Area Type and /or Manufacturer or Trade Name
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v v Adequate compliance with County and State regulations/requirements 1 �J . i
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Y Date `�-'r'�1' Z � Inspector L.1-' 4 / ���% ��, t
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' ' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE , d
t *CONDITIONS: t' '
• ' 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter i r
' 25, Article 10 C.R.S. 1973, Revised 1984.
_ 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- , +
} 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.
f) 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material i i.
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 f ine - 8 0
t " months in (ail or both).
f - White - APPLICANT Yellow - DEPARTMENT
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER Mt if 147a,
ADDRESS 617 [ oanr7 /1r/ 3 ,16 PHONE 6 ) 3 `/
CONTRACTOR /71'kC iSnlo
ADDRESS 6/7/ / cn'ty R,/ 9? o PHONE 6Z6- aa3
PERMIT REQUEST FOR (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town /Qclb.Son Size of Lot 3,5 AeReS
Legal Description or Address C ft 301 Rut 130 n
WASTES TYPE: (4 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES
( ) OTHER - DESCRIBE .
BUILDING OR SERVICE TYPE: Sony e Aiinay /tr,S/¢/rNee.
Number of Bedrooms 3 Number of Persons
()/,) Garbage Grinder ( )q Automatic Washer (x► Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: 00 WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 14/
Was an effort made to connect to the Community System?
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope c5iniiit -.5/or -1oav noi#N
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