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° G ARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT P N2 Z 3 1.8 - i •
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+' 109 5th Street Suite 303 Assessor's Parcel No. ) i
, Glenwood Springs, Colorado 81001
Phone (303) 945 -8212
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t L This does not constitute", r
1 ' f' INDIVIDUAL. SEWAGE DISPOSAL PERMIT a building or use permit. I,
t a PROPERTY �I c6-6-0 % '3C-1 J ,
.. Owner's Name 1 ' ,a��f �� )b"^1` ' Present Address - bDd Ca I �� ' Phone I .�- - XX`fO
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j System Location . 1 I
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' Legal Description of Assessor's Parcel No. (
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r SYSTEM DESIGN
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�Q &Septic Tank Capacity (gallon) —Other ' /
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, Percolation Rate (minutes/inch) Number of Bedroom (or other) 3 T �.LI r ,
8t S` 1`7 Kcci L P-if i 7�7F� y
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Required Absorption Area - See Attached 4 ,, I, 22. [,j -Q ei s1 1 /i t y
If $ : Special Setback Requirements: $✓z 4 I I
t Date / g Inspector t
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FINAL SYSTEM INSPE AND APPROVAL (as installed)
k Call for Inspection (24 hours notice) Before Covering Installation
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' ,, System Installer 0 z.
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I PI Septic Tank Capacity_ ' �,,,p '
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Septic Tank Manufacturer or Trade Name l-C f)
Septic Tank Access within 8" of surface . ___ + 1
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! ; f Absorption Area
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Absorption Area Type and /or Manufacturer or Trade Name ;
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w Adequate compliance with County and State regulations /requirements r_
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Other ;
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: Date ' \9_ Inspector {�.- - ` t
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
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d ( •CONDITIONS: r
y 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
7 25, Article 10 C.R.S. 1973, Revised 1984.
t Y 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 1 b
'; 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. �
s 3. Any person who constructs, alters, or installs an individual sewage disposal system Ina manner which involves a knowing and material ' 1
variation from the terms or specifications contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine — 8
months In jail or both).
4 % White - APPLICANT Yellow - DEPARTMENT ' '