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Glenwood sprinss, ct'"î"ãJãìuor Permit 5@ 8 {e
Phone lolo'¡o+s-iZlz Assessor's Parcel No'
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PFToPERTY
Owner's Name
This does not constitute
a building or use Permit.
Present Address
Ia Phone ë7*ñ v ¿--7--â* ¿> <-<) L)
System Location
Legal Description of Assessor's Parcel No'
SYSTEÍVI DESIGN
Required
SpecialS
Absorption Area - See Attache d 5 75- -Sq'
etback Requirements: /h7+ 5 Q
lnspector
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/a Pf) su ptic Tänk CaPacitY (gallon)Other
-{ PercolationRate(mínutes/inch)Number of Bedrooms (or other)
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Date
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
C"lf iol- lnspection (Za nours notice) Before Covering lnstallaiion
Septic Tank Manufacturer or Trade Name
System lnstaller
Sepiic Tank CaPacitY ãy
Septíc Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with county and state regulations/requirement= Y5s
Other
Date
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4 -a - /-s lnspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION S ITE
CONDITIONS:
1. A' instaration must compry with a' requirements of the cororado state Board of Hearth rndividuar sewage
Disposalsystems cnapiei25' Artícle 10 C'R'S' 1973' Revised 1984'
2.îhispermitisvalidonlyforconnectiontostructureswhichhavefullycompliedwithCountyzoningand
building requirements. connectioñ 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 consiructs, alters, or installs an individual sewage disposal system in a manner which
involves a knowing and material variation from the ierms or specifications contained in the application of
permit commits "
ó1"r. 1, petty offense ($500.00 fine - 6 months in jail or both)'
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