HomeMy WebLinkAbout277 Hooks Ln - 246510401006 - 1706-97IS VOID(Site Plan MUST be attached)
ISDS Permit # V
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY
P. O. BOX 179
EAGLE, CO 81631
328-8755/927-3823 (El Jebel)
* PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE 200.0
*
*
* MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
PROPERTY OWNER: �'"°''�� 6ua0'r K.
MAILING ADDRESS* e,0 X -22 3 \•
APPLICANT/CONTACT PERSON; J4'f 1- t16L. _ vfl
MAILING ADDRESS: 12T. ICY fir„ 0,
PHONE: _( 963 --a ►`S
PHONE: ( ) -1103 e S
3 `7c{ -2-` -%7
LICENSED ISDS CONTRACTOR: tiLL 16QNt'S PHONE:
COMPANY/DBA: E1lCJtvA'�Lo1-1 ADDRESS:
**************************** ********************************************
PERMIT APPLICATION IS FOR: (**New Installation ( ) Alteration ( ) Repair
***************************************************************************
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Building Permit #
(if known)
Legal Description: Subdivision: �Eb 1�0C< �kt-sc+i ling: _Block: Lot No
Tax Parcel Number: j i-d -0 0 -L--Q L & Lot Size • _-SS 4---
Street Address: VA,!:54=> � Q®
***************************************************************************
BUILDING TYPE: (Check applicable category)
(d) Residential/Single Family
( ) Residential/Multi-Family*
( ) Commercial/Industrial*
TYPE OF,,WATER SUPPLY: (Check applicable category)
(Well ( ) Spring ( ) Surface
( ) Public Name of Supplier:
*These systems r
SIGNATURE: _
*************
TO BE COMPLETED
AMOUNT PAID:
**********
3E
0
Number
Number
Type _
of Bedrooms
of Bedrooms
by a Registered Professional Engineer
Date
(6
RECEIPT #:
CHECK #: glaM
DATE: _
CASHIER:
0
t c lvz
�l
COMMUNIf
�•;7m6ti �.
�au2-�AeCLt eA 4-7n
�y9 x°'��p� �a�✓�� �0 �1
1/U6-97 Tax # 2465.101-01-006
Lot# 6, Red Rock Ranch GUNTHER
JOB NAME 277 Hooks Road
Basalt
JOB NO.
--"te%n i ew%ATir%m - /' C 1
BILL TO
DATE START D
qj�
DAZt COMPLETED
DATE BILLED
9,
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 ®@ NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 JOB FOLDER Printed in U.S.A.