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Glenwood SPrings' Colorado 81601
Phone (97o)945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name /Z PresentAddress
This does not constitute
a buildin or use rmit.
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DEPARTMENT
Permit S'Ø ZZ'-
Assessor's Parcel No'
System Location
Legal Descripfion of Assessor's Parcel No
SYSTEM DESIGN
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/AA3 septic Tank capacity (gallon)
Number of Bedrooms (or other) Z
7 Percolation Rate (minutes/inch)
Required Absorption Area - See Attached 7-sz seFf //¿furt/al+ 3P
Special Setback Requirements:4z a 3<, Fc ll EÉV t'31
Dato b-lnspector fl4
(as installed)
Call for lnsPection (24 hours notice) Before Covering lnstallation
System lnstaller L
Other
Q'4=A'/.=
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area {e
Absorption Area Type and/or Manufacturer or Trade Name z
Adequate compliance with County and State regulations/requirements
Sepiic Tank CaPacitY
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RETAIN WITH RECEIPT REC DS AT CONSTRUCTION SITE
Other
Date
GONDITIONS:
1. A' instaration must compry with arr requirements of the_cororado state Board of Hearth rndividual sewage
Disposalsv,t"*' cnapiei25' Article 10 c'R's' 1973' Revised 1984'
2.Thispermitisvalidonlyfor"onn""t¡ontostructureswhichhavefullycompliedwithCountyzoníngand
buirding requirements. connectionìo o,. un" with any dweiling or strr¡ctures not approved by the Building and
Zoning offìce sha, automaticary be a vioration or a requiremãnt of the permit and cause for both regar action
and revocation of the permit' i,.!r..^r .ricnnéat qrrcfom in a mannerwhich
3. Any person *f,o
"onriructs,
alters, or installs an individual sewage disposal system in a manner wh
invorves a knowing ancr materiar våriation from the terms or specìfications contained in the application of
permit "o*rir, u ölu"= 1, petty otrense ($500.00 fine - 6 months in jail or both)'
White -APPLICANT Yellow - DEPARTMENT
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