HomeMy WebLinkAbout03610 0
1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMEN ' Permit N2 3 6 1 0
1� \ � ' Assessor's Parcel No.
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute
INDIVIDUAL SEWAG DISPOSAL PERMIT a building or use permit.
PROPERTY 43,,K,...„ K" 30
Owner's Name a • - 4 . • Present Address
C e - - L 30 Phone 970 -9W( 34
a J., C2' . I1o35
System Location `-
Legal Description of Assessor's Parcel No. \
SYSTEM DESIGN
Septic Tank Capacity (gallon) Oth=
Percolation Rate (minutes /inc Number of Be _ • - (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND • • PROVAL ( installed)
Call for Inspection (24 hours notic: Before Covers g Installatictt
System Installer
Septic Tank Capacity
Septic Tank Menu' ac rer or Trade Name
Septic Tank Acces. within 8" of surface
Absorption Area
Absorption Area Type and /or Manufacturer or Trade Name
Adequate compliance with County and State regulations /requirements.
Other
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS:
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 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.
3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 tine — 6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT