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k: to Inspector
** Retain with psx°in tt rcoordc% at construction site.
COLORADO DEPARTMENT OF.HEALTH
Water Pollution Control Division
.4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
CL, -toc
Mail Address: afpj ( Z
CIty:�bUbQ��cfrPhone: ke p
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
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 (77;40,4'%;(e0 CI ty or Town C r��
Legal Description Lot Size: 7,5 4rN eS
2. Type of area and facility - Number of persons served:
Seye tr, oa c. +�1
Subdivision Motel Restaurant Trailer Court
Other:
3. Source of domestic water: Public (name):
Private: well Or. Depth Other Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District: A',ev
if so name:
5. Distance to nearest sewer system: k�: s
Have negotiations been attempted with owner to connect:
If refected, 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:
7. 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:
Date:
Est. Completion Date: Est. Protect Cost:
di
-signature of Owner
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