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r' r7 GAR FIELD C OUNTY BUILDING AND SANITATION DEPARTMENT Permit N ° _ 3 3 8 ,
i i• • i • 109 8th Street Suite 303 Assessor's Parcel No.
i ,, Glenwood Springs, Colorado 91601
Phone ( 303) 945.8212
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I 1 This does not constitute
1 i' INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY
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Ov/rier's Name r x / >» 1.)040,14 Present Address 't 7 4 6 `
R fl S I , )n Phone-1 `t ' " 1..6 ), ,
f. • a System Location L P G 0 n 31 \ , , P
4 '.r Legal Description of Assessor's Parcel No.
. t SYSTEM DESIGN
1 �I WOO M t W Septic Tank Capacity (gallon) Other '
t S d0 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 4. C. C, i
• /4z7 syT - fiocx (,zrgcq FncuD t r
' Required Absorption Area - See Attached 713 s y jx - L J./kw Cos./803- 39—'7 zucK3
8Sto St '' 44 4z.Ac» C»*-sv . R)- EV )
Special Setback Requirements: LA\
3.
I Date ! - 1 / Inspector h. !team t :! i
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7 ( FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) /
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i $ Call for Inspection (24 hours notice) Before Covering Installation ,
9 ( System Installer N/ � ? c 4 f 1, f
t,
f , Septic Tank Capacity /000 C 4
1 a.
!T. Septic Tank Manufacturer or Trade Name .
9 $
( , f Septic Tank Access within 8" of surface 944 ' r
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s ± Absorption Area 0 - - " �' _ . - •• -.„ _ �,- ynt 1 . ,
• h Absorption Area Type and /or Manufacturer or Trade Name 7� ! J the /0 ,
:t
e Ke
A dequate compliance with County and State regulations /requirements t t '
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4 . 14 i 4.
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" Date Inspector d / Q -A - \ L.) . : Other i
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RETAIN WITH RECEIPT RECORD AT CONSTRUCTION SITE j
d
*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. t. i
1 ' 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 7
nection to or use with any dwelling or structures not approved by the Building and Zoning off ice 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 installs an individual sewage disposal system in a manner which Involves a knowing and material } e
1 ! variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense (5500.001ine — 8 ., {
I f months in )all or both).
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I White - APPLICANT Yellow - DEPARTMENT J
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 1 )nN ..'}der tnid I
ADDRESS 40 %ham Ct.' Qi 11C PHONE 947 -9)?
CONTRACTOR Sr n1t M0. vk re 112
ADDRESS 7 z3 N,.> Ra S t< I O c. PHONE ct y r-nRR6
PERMIT REQUEST FOR ( )t) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town \ C o_4.ke Size of Lot ¶, OS acre
Legal Description or Address IA ?) en■ wrv.r r. rc`ner C A-)AW t s kw. 4 a 1 Or s“ e
WASTES TYPE: (Tg DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: {Ls'..I a.,4 4l
Number of Bedrooms 3 Number of Persons 7)
((,)' Garbage Grinder (t- Automatic Washer (c,) -Dishwasher
,SOURCE AND TYPE OF WATER SUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ?i I. s
Was an effort made to connect to the Community System? Ni it
A site plan is required to be submitted that indicates the followine MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table 4 n'
Percent Ground Slope u, I A s #e i s --Plot
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