HomeMy WebLinkAboutBlk 15, Lot 1,2 - 219726419003PERMIT NO.
Name of Owner:
Address of Owner:
ENVIRONMENTAL HEALTr
P.O. BOX 811
EAGLE, COLORADO 81631 PERMIT FEE $25.00
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ,. y
Is facility within boundaries of a city/town or sanitation district? T'\
Distance to nearest sewer system: C) `M Ve,
Phone:l�C?���lr i1�iC
Location of Proposed System: Legal Discription: � \� r'� 1i o<. !� U A
Type of Structure: Single Family Dwelling ( X ) Other:: �l !\ 'VL No. Bedrooms i
Water Supply: Private Well ( ) Location: Distance From leach field: !� ?
Size of Lot: J d x a Public Water Supply: } f/4
An appropriate plat plan must accompany site inspection for this application showing required information. (See
attached sheet.) The individual sewage disposal system will be constructed and installed in accordance with the
regulations governing individual sewage systems within Eagle County, and shall comply with House Bill 1553 CRS
66-14, 1973. Payment shall be made to the Eagle County Treasurer. Permit, upon. approval of this application, may be
obtained at the Eagle County sanitarian's office.
Appointment for final inspection must be made prior to construction by contacting the inspecting sanitarian. [Phone
328-7718 between 8:30 and 9:00 AM.] Refer to permit number. No approval will be given on any system without final
inspection.
Name, address, and telephone of person responsible for design of system:
The undersigned acknowledges that the above .information is true and that false information will invalidate the
application or subsequent permit.
SIGNATURE OF APPLICANT: ��/�-�-���! (= (W=6V'?--) Date: � -��'-� ��
(This application becomes inv lid 6 months from above date.)
HEALTH DEPARTMENT USE ONLY
Percolation Information: }
Tank Capacity: "1 gal (minimum)
Absorption Area:'' Sq. ft. (minimum)
REMARKS:
APPLICATION IS:
.APPROVED (,�<- ) DENIED
Permit No. 2 Cis
Fee Receipt: A/ hi
i
File:
The above individual sewage disposal system was installed by
AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH DEPT.
Date:
Sanitarian:
0036-Lots 1&2 Block 15 Fulford
JOB NAMf- Stuart (LC-S L'k'� 9 -�rA3 H 19 -o z)
JOB NO.
10011OR LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
C-1c Y—V(
PERMIT # 36
OWNER: A,
LOCATION: Lots 1 & 2 Block 15 Fulford (50' x 125')
INSTALLER: Owner
SIZE OF TANK: 1,000 (sealed vault)
DWELLING: Cabin
PERC RATE: N/A
(suggest a minimum of 1,000 gallon sealed vault)
Finalized: not listed
Application 8-07-75
ot q —
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
JOB FOLDER Product 277 @ NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MASS. 01471 JOB FOLDER Printed in US.A.
