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it. 1 r� • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 4 5 ? 1
Jt '\ ,7 109 8th Street Suite 303 A is Parcel No. ) '.
U Glenwood Springs, Colorado 81801 p ;
Si / Phone (303) 945 -8212
This does not constitute 3 '
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+. a building or use permit. .' e INDIVIDUAL SEWAGE DISPOSAL PERMIT i ,
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( r '. Owner's Name IZRti V IRG I l )1 A- Present Address ip 1 0 R 1nc1 L _ Phone /q
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System Location_ p I ) ` R Inc) { ' ' 1i ,t- ` A
r t Le Description of Assessor's Parcel No. ,
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• SYSTEM DESIGN C C AC N 1 ' C 11 a 0 £ R 2 ° I V N r 7 S
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i /000 — 1 SO O S eptic Tank Capacity (gallon) Other 0A'
. 1/ 1 �' 3 (S)
i Percolation Rate (minutes/inch) Number of Bedrooms (or other) it
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Required Absorption Area - See Attached
q Sp ecial Setback Requirements:
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Date . - I 6 — v 1 Inspector "�
1 1 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) et
f Cali for Inspection (24 hours notice) Before Covering Installation
r '} System Installer ozf),J e., $ t
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t j Septic Tank Capacity ( S 7 ZYT) 3 f
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6 f 1 Septic Tank Manufacturer or Trade Name (' OFF / 4) D
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Septic Tank Access within 8" of surface yE-47. t i
Absorption Area S edi C.Z X/. it 1 4c 11 ( ft- *4 t.--4 IA) 4 $Lb n i
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Absorption Area Type and/ot Manufacturer or Trade Name
1 l Adequate compliance v➢11h County and State regulations/requirements
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`j Other / o
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9 Date I- 01 Inspector 1 /` _.__:� t„ e .
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE e l
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1 ', *CONDITIONS: fl a
• t 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter l
25, Article 10 C.R.S. 1973, Revised 1984. 7
, s 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 V )
.,' 3. Any person who constructs, alters, or installs an Individual sewage disposal system in a manner which involves a knowing and material ! I
variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine —8
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• months In Jail or both). 4 I 'y e •
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