HomeMy WebLinkAbout2300 Lake Creek Rd - 210518102009 - 0142ISENVIRONMENTAL HEALTH(
P.O. BOX 811
PERMIT NO. EAGLE, COLORADO 81631 PERMIT FEE $25.00
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Np 321
Name of Owner: 6"— Phone:
Address of Owner: ,,&iZ /
Is facility within boundaries of a city/town or sanitation district? —&c
nictnnra to nanract cawar zvctam-
-*Location of Propc
* Legal Discription:
Type of Structure: Single Family Dwelling ( ) Other:
Water Supply: Private Well ( ) Location:
Size of Lot:
No. Bedrooms S
Distance From leach field:
Public Water Supply:
An approprigj@=DJjQt plan must accompany site inspection for this application showing required information. (See
attached sheet. a 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: Id"
The undersigned acknowledges that the above information is true and that false information will invalidate the
application or subsequent perm'
SIGNATURE OF APPLICANT: Date:
(Thi &plication becomes invalid 6 months from above date.)
HEALTH DEPARTMENT USE ONLY
Percolation Information: /DMZ"
Tank Capacity: /, " d gal. (minimum)
Absorption Area: /000 Sq. ft. (minimum)
REMARKS:
APPLICATION IS: APPROVED ( ) DENIED
Permit No./4/8
Fee Receipt
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: /-- /3-" 7Z Sanitarian: � Lz,
Je �QJ
PE1tcOj..; T1014 TEST
Fee:
1pnlxcn tion No. '-'crmit No.
Owner:
ter-- •
Leal Description:. 4.3
b
Tyne of UwellinrQ No. of Bedrooms:
r
Date of Test: 10-12 Denth of Holes:
Diameter: Tyne of Soil: Z—C�1.--�'
Locv.tion of Test Holes: 2 L)
• �� ��
Test hole 1vas nxesoviced from:To:
Time Date Time Date
LE
TIME
I A-TE R DEPTH
j INCHES 0F FI+i,L
RATE
l
L
3
1
2
3`
1
2
3
7 ~i
2
3.
V.
10
Percolation hate:
Site has been reviewed -and testefox :crcolation. x'ite.'
We 'reconimend /PkROVf'L DiS1PP,ROVAL Df TL:
/10
. Js'ut-i�.•onmrnt:�l llc;;lth ,
J.aulc CouciLy
0142-Lot 4 Block 2 Lake Creek Mead'
JOB NAME %s�! � 2-0 �—O 2A)q JOB NO.
i nCATMN
BILL TO
I im
PENN
DATE STARTED
DATE COMPLETED
DATE BILLED
2012. Ne-� Po
,
a e,- oa&�
Qe-w Ads ssD
cc) L.Qke, Creek Uo^
lie wey- SUL,
S
enn R2�L-5
�3 --2) 2
JOB COST SUMMARY
TOTAL SELLING PRICE
PERMIT # 142
OWNER:
-Block 2 Lake Creek Meadows
LOCATION: Lot 4 B10
7:77
INSTALLER: Don Pressley
SIZE OF TANK: 1,000 gallons bedrooms x 200 sq.-ft.
DWELLING: Residential - 3 bedro minutes (600 sq ft.)
PERC RATE: one inch/10
(suggest 600 sq. ft. of drinage field)
By: Erik Edeen
Finalized: 6/11
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
Printed in USA
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