HomeMy WebLinkAbout10920 Hwy 6 - 211104200002ENVIRONMENTAL HEALTH
P.O. BOX 811
PERMIT NO. EAGLE, COLORADO 81631 PERMIT FEE $25,00
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Name of Owner ' !y/�P �f '� Phone
Address. of Owners
Is facility within boundaries of a city/town or sanitation district?
Distance to nearest sewer 'system:
Location of Prol
Legal Discriptioi
Type of Structure: Single Family Dwelling ( Other: No. Bedrooms
Water Supply: Private Well ( Vi ) Location: '" r: 7"�'�!f Distance From leach field:
Size of Lot: ,i'r .�,�r�[', Public Water Supply: AIZ-
An appropriate kplatplar� must accompany site inspection for this application showing required information. (See
attached sheet.) ITTie 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'without4inal
inspection.
Name, address, and, telephone of person responsible for design of system:/
t _::�,. iC.'"k:::.L1f%_i'' � ic; .f , .�,' i .`�%f7� �f?t r ,U i !l •c�-^, s, �(% / :.�/�'./.�/ll
The undersigned acknowledges that the above information is true and that false information will invalidate the
application or subsequent permit.
SIGNATURE OF APPLFCANT�t"-':�'c-e z--.?'e•'%�"`�f Date: i a�
(Thi application becomes!'invaldd 6 months from above date.)
HEALTH DE ,EI TMENT USE ONLY
Percolation Information: ~ "`'� Permit No.
Tank Capacity: i'Z4l� gal. (minimum)
Absorption Area: - Sq. ft. (minimum)
APPLICATION IS: APPROVED ( DENIED ( )
Fee Receipt:. �`! .>' i 1l
File: 1/
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: _
HOLE
PER-COLPTION TEST
Fee: 5-0.00
I nlication No_ -�2 1"Prinit No_
Owner:
Leja.l Description: 61
Tyne of Dwelling: No. of Bedr"ooms:
Date of Test: Derth of Holes:
Diameter: Tyne of Soil:
Locstion of Test Holes:
Test hole was nresoaked from: To:
Time Date Time. — Date
TIME
WATER DEPTH
i
i INCHES OF FALL
RATE
1
2
3
1
2
3
1
2
3
1
2
3
WZ
�z7
`f
l
413IIv-
/ ;/
..Percolation Rate:
Site Iias been reviewed and tested for r.,ercolation rate.
We recommend: P-PPROVAL DISIPPROVAL DI TE.
dal
T Erik N. F.deen, 13..P. S.
Environmental Health
Eagle County
o- 0 44 co
� m a S A o
'0co
n •tom+, N o -0 . °' $4 m "� 006,
v a.0�►Or m +1O m43
� asw� m r �p d0 dO
cu c-
�o r, w d o -Hc Q N o
o tU A � ►n � e>d '5 4- N 00 o y d� P1
'O
oM poo?J . OS o ° -tP4-1 o v
� i N o
O .A� 1
O
O/9 3., 0P, fi 00m! N � s � m '^ -P r `d 4 u o 0 m
F' 1 tol a) K qo g71 o a,� f�
C i 3 d fi0 0 -r4 O% -H cd
O Jh �0 3 �4 � H r♦ OC) 14 \O d `tde
to
t� w o n 'rya cd
>, ,fly +i 1i «Q7rya .�
. T
0,4 V .0 41 ed 44 cd OO -H CON
uoi x o � r>'i O too mho � � � e�+d
E• m _ '� � co Cd 0 � cd 93" N O VlO • mom , \
O O ON
V y O h �� Oa O 4) -H 0 $4 8 O N
O� O C m O QOi � 0 4r 3. m O
��h y E+ O z O T�CV Is 0 Sr O 40 O Id
bD °6 4- z o +1 Id &0 +l `d In
W4 q a
O • P, t~ 1-1 La ao Cl) +/ ++ m
p z o° a° o >, I m m °' a
to f
.0 0 to 0 to
- ,v 0 +0 4d ed O
U � FW N w4 4C ??4) � O
i+AtU
O O .0 O fJ01 F� 'd 4D `
,nArt � VO ' 1 O aO m
r 4 A,; z�4 td4 6 m A w
11
0065-11 Mi E of Gypsum Tract 64 T5 S
JOB IVAlOII R85W 10920 Hwy 6 Gypsum Lawrence
JOB NO,
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
1
710 CKL-�
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 U.S.A.