HomeMy WebLinkAbout133 Fulford UNKNOWN - 210904101003EAGLE' UNTY DEPARTMENT OF ENVIRONV 'TAL HEALTH
Box 81 1 6th & Broadway
Eagle, Colorado 81631
(this does not constitute
PERMIT Eby F a building or use permit)
Owner.._,
System Location
Licensed Contractor
* Conditional Construction approval is hereby granted for agallon
Septic Tank or . Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate inches in minutes sq. ft.
absorption area per bedroom
# of bedrooms xsq. ft. minimum requirement
May we suggest
Date �mot. Inspector z
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approved prior to covering any part.
Septic Tank cleanout to within 12" of final glade or !"ellr
access ports above gr
Proper materials and assembly.
Adequate absorption (or dispersal) area.°
Adequate compliance with permit require ents.
{I
Adequate compliance with County and tate regulations/requirem�
Date Insp
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 25-10-104, CRS 1973 amended 25-1-614, CRS 1973
2. This permit is valid only for connection to structures which have fully complied with County Zoning and
building requirements. Connection to or use with any dwelling or structures not approved by the building
and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3. Section III, 3.24 requires 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 con-
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or
both.
ENVIRONMENTAL HEAU TR `
P.O. BOX 811
PERI MIT NO. GAGLE'COLO@&DO 81831 PERMIT FEE $25.001APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Nome of Owner: Phone:
Address of Owner:
Is facility within boundaries of o city/town or sanitation district?
Distance to nearest sewer system:
Location of Proposed System:
Legal Discriptionw
Type of Structure: Single Family Dwelling Oth �r--- No. Bedrooms
VVo|or Supply: Private Well ( ) Loco,iince From leach Ge|6:_____—___
_
Size of Lot: k Public Water Supply:
An appropriate p|o+ plan mum accompany site inspection for this application showing required information. (Se**
attached sheet.) The individual sewage 6iopono| system will be constructed and installed in accordance with the
regulations governing individual sewage systems within Eagle County, and s6o|| comply with House Bill 1553 [RS
66-14' 1973. Payment oho|/ be made to the Eagle County T,eouvne,. Permit, upon approval of this application, may be
obtained at the Eagle County oonitorion'soffice.
Appointment for final inspection mwm+ be nno6e prior to construction by contacting the inspecting sanitarian. [Phone
3O0-'7lBbetween @:3Qand 9:WWA88']Refer *upermit number. Npapproval will 6egiven onany system without final
inspection.
Name, address, and telephone of person responsible for design of system: X�, Z
The undersigned acknowledges that the above information and that false informationU invalidate
application or subsequent permit.
SIGNATURE OF APPLICANT: Date:
(This application becomes invc�,W 6 month's from above date.)
HEALTH DEPARTMENT USE ONLY
Percolation Information: Permit No.-
Tank Capacity: (minimum) Fee Receipt:
Absorption Area: Sq. ft. (minimum) File:
APPLICATION IS: APPROVED ( ) DENIED
The above individual sewage disposal system was ina/oUe6 by
AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH DEPT.
Date: Sanitarian:
Px._;CULA-TIGN T.EST
AN SITE iNczPECTIUiT � 1 EE >Sp . 0^
PE'i'IT
I4O.
OWNE
r
Street
Address or Leal
Description:
z tj /S'jf
of
DO 3T0T TI ITE "tiG T THIS LINE
Date of
Test:�',6-7
Depth of hole:
•'j Dia—Meter: 7'yD,e of soil:
)LI
Location of Test Hole:
Test hole was presoaked from: To:
(Tine) (Date) (Time) Date:
TT;.F
:7-r 1 1 2 3 !;
Ci
t•r,^r;> ?ir;'�Tti
1 .. 2 3
I'Tc: :nr. F;�t.r
1 � 2 3
pvl.r r
1 2 3
Z'
i.
3
Percolation Rate: iIl�I
Site has been reviei.Ted and tested for percolation rate.
We recor;—m end: APP ;UVAL VAL( ) Date: . ,57
NOTE: Plot ,plan S'=o in- boundary lines, location of o- oposed buildins or buildi I *s
and desi-n of septic syste-m must be submitted II-ttil t�p�lication for Permit to Construct.
The back of this form may be used to show plot )Ian and design of system.
�r C
Sanitariani
P. U. Do;.: 811
Telephone (303) 328-7715 Earle' Colorado 51631
i
J,51 Acre 5
11
0002- Ot 7 Kaibab
rwin
JOB NAME-
1
B LOCATION
BILL TO
DATE COM
DATE BILLED
77
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 ®o NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MASS. 01471 Printed in U.S.A.