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` ~ ~ 8 7 PERMIT # <br />~_~ SAN JUAN BASIN HEALTH UNIT <br />- DLIRANGO, COLORADO <br />3803 No. Main AVe. a. o. eox ~.o *c~c.vovc a.~-s ~oz <br />81301 a•v-s voa <br />wv-svo. <br />APPLICATION AND PERMIT TO _INST_ALL~ CONSTROCT, ALTER, OR REPAIR INDIVIDD <br />PERMIT EXPIRES 120 DAYS FROM ISSDANCE / <br />OWNER OR SPONSOR: ~~ ~~j~f~~~~JJ~~~Lf~ yQG ~~,lbfjjjj RECEIVED <br />MAILING ADDRESS: f~(L,~,/rl~/~}..,/lL!/1B/l~o clnv A(A 190 <br />ADDRESS OF SITE: -S '7 "7~~~~^^^D7777^^^/`"~~(' ~ /~D -fRHi--d-EF~ V <br />..? / Qe~onND <br />PARCEL NUMBER: DIVISION <br />G7?~7i?y A7. INFORMATION: SEPTIC TANK ~oZ.Y <br />n ,~ ~ <br />1. Living units j CXi qyg~~ iquid capacity ~GYA'JV~(: Mat. py~r~ <br />2. Number of be rooms EXTENDED AERATION: <br />3: Number of bathrooms <br />4. Automatic laundry t~es 1. ity _ <br />5. Garbage dis osa7. __~~ s___ 2. Final trE <br />6. Lot size ~3~~-~~ d-/-t subsurface rge <br />7. Water supply ~/~ ~ b. surface discharge <br />~, ~~'~ ' SOBSDRFACE DISPOSAL: <br />8. Percolation rate ~~ iM . <br />9. Soil profile ~ Bed ~i~{ ?Lines ~ Length ~Q /~ <br />~,o/~ LC~Q/H Width~DepthCover 1 > "~' <br />10. Bedroc depth _ 7 Q'~ ~O ii <br />11. Water table depth ~ ~N' <br />Bottom <br />COMMHNTS: Slo <br />•Q/ Gls~ S~~Sed~~ yOr f~ ro~~ ~owh s-~ie~n/ sia~>/ o-~secarlQ/ <br />a,->~, . _ <br />ram ~ eQSeirt~•• <br />© /~! a~~ ~d'~e~ run off erf~l ~ sides c~ P cz~a 6~~ w~u~ /ins <br />ero~sty w,-I-h 5~~. 80 ov .~~~ c.~~easi~ eMC%s~~~ S~ y0 <br />~% ~0~7e: ra~b .Std ~"y//~~0 'f~j r'O/~G~ly ~i f ~e ¢/~/C~~~v Pr+~' Ov Pit/ ~i ~~ <br />CJ /1~~6G~ca ~OQ~ ,OG~pl1c~G .7'+'t7.++ ~Ea r~l T/P~~ 'tLO mQirt /r/-t~p~iot~ , ~../~,. <br />AGREUwrlm: ~ U yji'+~++ L4A7~~ S !d $~z~ ~Ot~~,~~,P/G7~~ '~"O d/vevt /rriOa-(iu n ~~ <br />This system ~~Sfi~S~ruc ed in a o/rdance witJn'~he above specifications and regula- <br />tions governing individual sewage dispo11 s''al systems of the S n Juan Basi"n~~Healt~h_De pt .~j 7 '1 <br />DATE: APPLICANT: V ` ~/G~""Qtj~a ~,/j/~/~r•e~ap.~//w~~[ ~~d'/ '~J <br />The pla s a d specifications as shown are approved, pending paymen of fe y <br />INSTALLED BY:~ SANITARIAN ~ •J <br />PERMIT FEE: $ ~~ RECEIVED BY ~~ ~ DATE: ~7 <br />A FINAL INSPECTION IS REQOIRED ~~ ~~ C / ~ ~~ <br />Location of tank/control panel <br />The above system has been inspected and found to comply with the plan and description. <br />SANITARIAN: DATE: <br />