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4.GCJ GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N_ 3 5 1 2
� (' \ \ 109 8th Street Suite 303 Assessor's Parcel No.
};L Glenwood Springs, Colorado 81601
.U' Phone (303) 945 -8212
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\ This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY � h (
Owner's Nam y` �/ �7O p W bPr Ui (�uA Present Address �`•l 1 WVI' EL V BBL_ Phone .37 P8103_
System Location_lSo NUI.RrcGr* bit •
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon) _Other
Percolation Rate (minutes /inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
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 Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and /or Manufacturer or Trade Name
Adequate compli / n /, ce with County and State regulations/requirements
Other __
Date_—. ° Inspector 0 71Q""""-
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 aviolation 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
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6
months in jail or both).
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