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,ed $ i'r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 3 4 1 6 ' + ,c
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601 a
i + Phone (903) 945 -8212
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This does not constitute e "
1' INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. I g
PROPERTY I'
c Owner's Nam l' -1<� Nh\(�) Present AddresX k 0 L) ( l 0 0 Phone 90 2-5').3
% : - 79 ( 31 1 r L3 �FI STL F
) S yA1em Location / �;— /
j ` Ligal Description of Assessor's Parcel No.
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SYSTEM DESIGN
i ! , 1 So Septic Tank Capacity (gallon) Other
t ' \ \ \ � U '.' ..
' 1 . 3 Percolation Rate (minutes/inch) Number of Bedrooms (or other) / t
W D svi')b -n 64/4-JFi- LE.4CK BL-e OK,
v Required Absorption Area - See Attached 'G9 p / t 4C + G/{1t,ttens /tJ )S Eta (Ci - 3X6 et S�-Z 1(�,oR
' f Special Setback Requirements: '7 4 " L€ V ` 5 / J ) JC is 3 9r i
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. hifi Date in— Z 1 - Inspector
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' f FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
r Call for Inspection (24 hours notice) Before Covering Installation . 1 j
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System Installer Of.) I4-T � ,
0 Septic Tank Capacity ') # °
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Septic Tank Manufacturer or Trade Name Cent
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Septic Tank Access within 8" of surface
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Absorption Area ('.
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Absorption Area Type and /or Manufacturer or Trade Name 3 2 4 t l i -p � / 'tf l R-44t c ( 9 t
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' Adequate compliance with County and State regulations/requirements l in a )
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■ k Other ` / 1 . 10o C/0.6 -? lt-o ook Ji,'m. p
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i Date (.. O � Inspector s , / : .rt ! ! . _ u f l3J ✓ t
• • ' RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE f
3 *CONDITIONS:
• r 1. All Installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter t,
25, Article 10 C.R.S. 1973, Revised 1984. t 4 t
( 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - 4'
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. f
r • t 3. Any person who constructs, alters, or Installs an Individual sewage disposal system in a manner which involves a knowing and material ?p
I7 variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine -8
R 1 months In )all or both). i R
r { ________�.......W..._.. _..._ Wh ite - APPLICANT Yellow_ DEPARTMENT _____....)._
