HomeMy WebLinkAboutBlk 11, Lot 3,4 - 245 Main St - 219723411004ISDS Permit
Building Permit # g
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE- EAGLE COUNTY
P.O. BOX 179
EAGLE, CO 81631
328-_8730/927-3823(Basalt)
PERMIT APPLICATION FEE L150.00 PERCOLATION TEST FEE $125.00
PROPERTY OWNER: MEy,\n\ C 1���21 V tT Tuw�
k' MAILING ADDRESS: [3, Q,�>O "� j }��w ��S,,CO((,3 PHONE: 3p3- 9a&-.20?7
APPLICANT/CONTACT PERSON: S ✓t �� ra5 C u ►vE� PHONE:
LICENSED SYSTEMS CONTRACTOR:
S4 Wte 115
ADDRESS: PHONE
********* X*****r******************************************************
PERMIT APPLICATION IS FOR: f NEW INSTALLATION ( )•ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUA`L SEWAGE hSPOSAL SYSTEM:
Legal Description: '
Parcel Number: Lot size:
Physical Address: r
BUILDING TYPE: -- (Check applicable category)
pq Residential r�-�*+��r� ,-�,�1„ ` Number of Bedrooms
(-) Residential / Multi -Family* Number of Bedrooms
( ) Commercial / Industrial* Type
HOT TUB Yes ( ). No
WATER CONSERVATION PLAN: YeS ( ) No
TYPE OF WATER SUPPLY: Well( ) -Spring ) Surface ( )
Public ( ) Name of Su plier:
Give depth of all wells within 200 feet of system:
*These systems require design by a Registered Professional Engineer
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
":,_�SIGNA
DATE: AsIT
AMOUNT PAID: f �J
I S � RECEIPT# � � % � DATE
CHECK CASHIER:
TIME LOG
Travel Perc Final --
Al 4- /AJ S 7toe el-- Zol
-
r
1087-91 TxPrcl#2197-234-11-004
JOB NAME Lots 3 & 4, Block 11
Dennis/Cherie Vittum
JOB 'NO.
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
i5� U1 1 no CASV> � `vlc� 1S uc
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 278 �o NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 41471 JOB FOLDER Printed in USA.
