HomeMy WebLinkAboutApplication-PermitGARFI LD (nom DEpArcr:srrr OP E1ivIR1o1a14 AL A1,'rR
2014 Blake Avenue
Glenwood riwood 'lprirtgao Colorado 81601
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Ccntractor
1. Construtiior, aiyraval
Plans and locait or: are hereby approved.
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2. Final. approval of systems
no system shall be deemed to bc in compliance with the Sewage
Disposal Dews until the assemb. ed system is approved prior to
covering any part.
8" se tic tank olearrout��as seal
r materials anc! assembi
Ade uate absarpticzi area
Adequate cor,orete paver td welis on�
A✓4- 1 Covenants si ned
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4e Retain with permit records at construction site.
COLORADO nEPART1irNT OF HEALTH
litter Pollution Control Division
4210 East lith. Avenue
Denver, Colorado 80220
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ArFLICATION FOR AL•PROIAL OF LOCATION FOR SE(TIC TANK SYSTSt4S
Applicant
Mail Address a A3 wm.City: . S , __-- Phones qN!-, /S71;7
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach overate sheets or report showing entire area with ;respect to surround-
ing areas, topography of area, habitable buildings, location of potable water
wells, soil percolation test holes, soil profiles in test holes.
1. Location of Facility: County CAPkg•ProkAZ City or Toon:
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Legal DescriptionT s A g a cs I n P Lot
Type of area and facility - Number of persons seared: 3-d�
Subdivision :4ote1
Other:
3. Source of domestic waters Public (name):
Privates Well Depth Other Depth to first ground water table
4. Is facility within boundaries of City Sanitation District:
Restaurant
Trailer Court
NINEY
If so names
5. Distance to nearest sewer systems
Have negotiations been attempted with owner to connect:
If rejected, give reason:
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours:
T. Name, address and telephone of person who made soil absorption tests:
8. Name, address and telephone of person responsible for design of the system:
9. Est. bid opening date: 3st. Completion Date: Est. Project Coat:
Date:
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