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sianwood '..; rings, Colorado 81601.
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Date
Intpec tori
2, Final approval of system:
No system shall be deemed to bc in compliance with the Sewage
Aisi:osal Laws until the assemb%ed system is approved prior to ,
covering any part.
L2(
tim se tic tank cleanout with as seal
Pro *r materials an( assemb
Ade•irate absor ttoi ares
NA Ade • ate concrete cover d rrelle on
[71 o+rarran*.es a1gnt d
*a tiu)ta[f with permit records at construction site.
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(G:.,t;i yio01)
APPLICATION FOR TUDIVWUAL SWAM DISPOSAL SYSTEM PERMIT
RECEIPT #k J5 �...
OWNER: .CL Z21'f✓lia A.;jr'R.E;sS;.. ._ 15ax a. rD ClA,Q p, F IOIVF;:A-f 5-76-4
CONTRACTOR: ,„PHONE:
SITE LOCATION:��sRitimgo$ i,D, 01' issEtlR,D i1.Sa
SIZE Or LOT:
Application for an individual sewage disposal perinY t: is hereby submitted. The
individual sewage disposal system will be constructed in accordance writh the
regulations concornin• divi.duai sewage cUspx:osai. systems within Garfield County.
t
DATE:
1
pplication is :>w id for six (6) :want fxrrn dao.e signed.
•
SIGNATURE:
Perculation test results
Recommended minimum size. of system
Reconanended minimum si.2:e oa tank: 0
Minutes per.TM';tv.,��„__
4
OT PLAT &LL
A.
( nn
DATE: SANIT).RIAN:
COLORADO DEPARTMENT OF HEALTH
DIVISION OF ENGINEERING AND SANITATION
ACTIVITY REPORT Code
Section
FILE REFERENCE: .s.�
County (✓
INDIVIDUAL OR
ESTABLISHMENT:
ADDRESS: # 2 .
NARRATIVE:
2S -•
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"ez-ed
7gdoe,/' ,/ 2 4, 7)/2
/i-2
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:
ES: 7 (Rev. 6-70-100)
, 1975.
REPRESENTATIVE: