HomeMy WebLinkAbout430 King Ranch Rd - 210335200006INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 1242
Please call for final inspection before covering any portion of installed system.
RETAIN WITH RECEIPT RECORDS
APPLICANT/AGENT: 1 OWNER: /�
PERMIT FEE f PERCOLATION TEST FEE E y 4� w-^� RECEIPT # l V y/ 9 CHECK # i� S
ISDS Permit # t Z
Building Permit #_
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE- EAGLE COUNTY
P.O. BOX 179
EAGLE, CO 81631
328-8755/927-3823(Basalt)
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $200.00
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PROPERTY OWNER: Liter c�
MAILING ADDRESS: i2s��,-1_ 5400, ,4UBN, eo ( /&-2- o PHONE • -%,1
APPLICANT/CONTACT PERSON: ITILAv15 �PHONE: %7v- S/S�
LICENSED SYSTEMS CONTRACTOR: w AcRd- CX�� A-4-iq 3
✓o N E, vtSpt
ADDRESS: -_ UeYGE CC-D PHONE 10�
PERMIT APPLICATION IS FOR: t/4- NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description:
Parcel Number:
Lot size:
Physical Address:
OF s o yu�
� ��e.��
-Cc L� CYN—
BUILDING TYPE: (Check applicable category)
-Residential / Single Family Number of Bedrooms
( ) Residential / Multi -Family* Number of Bedrooms
( ) Commercial / Industrial* Type
TYPE OF WATER SUPPLY: Well (�4 Spring ( ) Surface ( )
Public ( ) Name of Supblier:
*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"
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SIGNATURE: , DATE: c -I / - `(
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AMOUNT PAID: �� V • � RECEIPT# DATE: * (o / I 1 ) q3
CHECK # 95ELc CASHIER:
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER: �Cj
LEGAL DES^? IPTION:ng� Pw* 10-� �
MAILING ADDRESS:
TYPE OF DWELLING: NUMBER OF BEDROOMS
TEST HOLES PRE-SOAKED: YES le NO
TIME tJhMVn T1anMTT
Time to drop last inch
PERC RATE: MINIMUM SEPTIC TANK SIZE:
MINIMUM LEACH FIELD SIZE:
COMMENTS: t;?-I() f 01 r7 66d) ,<1R7 in 'i7n �.,/+i l�r A
PERC TEST DONE BY:
f_ / - / I — DATE:
Environmental Hea th Officer
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1242-93 - Parcel #2103-352-08-006,
0250 King Ranch Road, Grouse Bar Ranch, Beck
JOB NO.
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
-
7
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
MA 01471
JOB FOLDER
Printed in U.S.A.
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