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I. :, Permit N 3 2 6 0
Aasesagr's P arcel No. j
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F $ Percolation Test $100.00 •.,�� f �`�, i • �, �. n . ( r
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 3 2 6 0
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute
t � (jam a building or use permit.
INDIVIDUAL SEWAGE DISPOSAL PERMIT po h( o') 1 / O
PROPERTY l
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Owner's Name \ 1 \ L q) k) Present Address ° t!% r
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System Location Oi C / // 'r
Legal Description of Assessor's Parcel NA.. - -- VVV
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SYSTEM DESIGN
Septic Tank Caf g.
/ / -) A Percolation Rate (m 'i i ) N , of Bedro• I (or oth (
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Required Absorption Area - See Attache Ag ,
Special Setback Requirements: t
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity —_— ,
Septic Tank Manufacturer or Trade _ 1` `+
Septic Tank Access within 8" of surfac ' _
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r '4 .'... 413 ' ...
Absorption Area __ L p' , - - I " a ' ellslwlt.
Absorption Area Type and /or Manufacturer or : Name _ -- -- -
Adequate compliance with County and State regulations /requirements _
Other - -- - - --
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
•CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con-
nection 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 constructs, alters, or instails an individual sewage disposal system in a manner which involves a knowing and material
variation from the terms or specifications contained In the application of permit commits a Class I. Petty Offense ($500.00 fine -8
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT