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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Nf - 3 6 2 e
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
■ Phone (303) 846.8212 ���\
• c This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PRQPERTY ( j� Z I� /, C �( j
Owner's Name J�1 J' $ I £ ' // r esent Adl ddr `� /��fv "/ S 00 QI`�- 1160C I l��j° — l�V
• t System Location U�DI� 'T _. 1\l �`, ���`.J� \'� �W ✓ �� ,
Legal Description of Assessor's Parcel No.
SY DESIGN
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Septic Tank Capacity (gallon) Other
t ) • • 756 �� -1
/ / Percolation Rate (minutes /inch) Number of Bedrooms (or other)) n 4 ~"' t - - 0
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Required Absorption Area - See Attached �'
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r Special Set Requirements: yolk # P' / � 9, -✓'°
Date / /6/ - Inspector ](� /(�Gtlithi — t" ,('
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ,
1 Call for Inspection (24 hours notice) Before Covering Installation
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System Installer (Mitt* t
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( Septic Tank Capacity 12'9)
Septic Tank Manufacturer or Trade Name yn 6 f 0-'LN� }� M � -° '\
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Septic Tank Access within 8" of surface \ �(J
Absorption Area 1. q t A, V A' ( xA �H^ Y -
i Absorption Area Type and /or Manufacturer or Trade Name I /r. ' 4, .SL.t
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Adequate compliance with County and State regulations /requirements tAR 2� i •
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Other n - •
Date Ill 11II \ 0 Inspector A )� (i f 1 v 'i - c; ��— r
t RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE t
*CONDITIONS:
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• 1 . All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter a
25, Article 10 C.R.S. 1973, Revised 1984. E
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- ' F
nection to or usewith 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.
• 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 line —8 . i
months in jail or both). }, r
White - APPLICANT Yellow - DEPARTMENT 1
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