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0 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N °_ ` - 3 A 2 � e '
4 109 8th Street Suite 303 Ass essors Parcel No., i i
Glenwood Springs, Colorado 811301
, Phone (303) 945 -8212
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1 INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
° PROPERTY
Owner's Name 8 :0 ' , Ch Present Address A' ` a A • Phone
f . System Location 0001 2)e / og CiRc % Glenwood sf '2IAJS a F /6of
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` Legal Description of Assessor's Parcel No. �■, tS F / n ' ' So t 4
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r r, SYSTEM DESIGN
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t Septic Tank Capacity (gallon) Other
4 f Percolation Rate (minutes/inch) Number of Bedrooms (or other) i.
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Required Absorption Area - See Attached
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Special Setback Requirements:
i Date Inspector i e.
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
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Call for Inspection (24 hours notice) Before Covering Installation
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• i ! System Installer
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Septic Tank Capacity
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Septic Tank Manufacturer or Trade Name t •
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Septic Tank Access within 8" of surface •
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i ,, Absorption Area
) Absorption Area Type and /or Manufacturer or Trade Name
Adequate compliance with County an State regulations/requirements 9
1 Other / 1 C r (/J/}�,¢�
€ f Date ( O /r OO Inspector f fit-
Q - 4-9-4 )
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE ` +
*CONDITIONS: c'
° 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- 4 1
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation ors S
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 materia
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.O01ine -8 • i q
months in )all or both).
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