HomeMy WebLinkAbout62 Blue Creek Overlook - 239127106007 - 1061-91IS VOIDJI V r 'n 0j
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ISDS Permit #
Building Permit #
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 $150.00 PERCOLATION TEST FEE $125.00
PROPERTY OWNER:
MAILING ADDRESS:
APPLICANT/CONTACT PERSON:
LICENSED SYSTEMS CONTRACTOR:
ADDRESS: A-)��i/ /
PERMIT APPLICATION IS FOR:
LOCATION OF PROPOSED INDII
Legal Description:
Parcel Number:
Physical Address•
W3- 43Z
PHONE:
PHONE:6ellw-
263, z233
PHONE:
NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
SEWAC�: DISPOSAJ, SYSTEM:
size:
i cf-'/ �/ �/ �" .tti✓ice/n\A/� U
BUILDING -TYPE: (Check applicable category)
Residential / Single Family Number of Bedrooms 0/
( ) Residential-/ Multi -Family* Number of Bedrooms
( ) Commercial / Industrial* Type
HOT TUB - Yes
-- ( ). No
WATER CONSERVATION PLAN: Yes No ( )
TYPE OF WATER SUPPLY: Wel ) Spring ( ) Surface ( )
Public ( ) Name of Supplier:
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"
SIGNATUR'.
********
AMOUNT PAID: RECEIPT#, V
CHECK #
TIME LOG 3f�
Travel Perc Final
DATE :�� � 5V
****** **** *************
DATE :•cam
CASHIER-
.
1.
aff
Oxford
0 ESSELTE
MADE IN U.S.A. NO. R 752 1/3
• • • •
1061-91 TxPrcl#2391-271-06-007
JOB NAME _ Lot 21: 0062 Blue Creek Over -
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JOB NO.
BILL TO
G� �l
DATE STARTED
7ATE7MPLETED
DATE BI LED
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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 eea ® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 JOB FOLDER
Printed in U.S.A.