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Q,_ <br />i <br />~;~ - Headtlt <br />Epactcnent <br />DATE: 7/5/2005 <br />Tax Schedule # <br />Construction Address <br />Subdivision <br />Owners Name <br />Applicant sam <br />Installer Name: <br />Environmental Health Division 750 Main Streeu P.O. Box 20,000-5034 Gand Junction, CO 81502 <br />970-254-4141 <br />Individual Sewage Disposal System <br />Permit <br />Cfty State <br />Palisade CO <br />Lot Block ~ Filing <br />Address Cil <br />4/10 Road Palisades <br />New ^ Modifiption G Year Round <br />^Repair ^ Enlargement ^ Seasonal <br />^ Aheration ^ Relocation # of Days 0 <br />Square Footage 2200 Garage r_~ <br />Single Family Multi-Family <br />^ Frame/Manufactured <br />Permit Number <br />012481 <br />Application Number <br />05-215 <br />^ Standard Design <br />~ RPE Design <br />^ Tank Only <br />Zip ^ Terra Lift <br />81526 <br />Parcel Size 45 <br />StatA Zi <br />CO 81526 <br />RPE Design by Lronk Construction <br />^ Public <br />^ Well ^ Cistern ^ Spring ^ Surface <br />Other ~ ^ None <br />Type of Business ~_ <br />Maximum Sewage Flow Rate <br />'Number of Employees <br /># of Shifts <br />^ Mobile Home # of Units <br />of Bedrooms ~ Bedrooms per unh <br />^ Washer # of UnHs wlCbtheswasher <br />^ Disposal <br /> <br />^ Basement Plumbing # of Units sJGadtage Disposal <br />^ Commercial Basement Plumbing <br />T e of s stem <br />RPE <br />Trench La out Bed La out LJ ~ Graveless System ~ },, <br />1` <br /> Grvls Type <br />Building sewer depth Total Trench Length ~ Bed Length ~ # of units ~ t <br /> Each Trench 0 # ofLaterals ~ Length [~ <br />Tank Volume # of Trenches ~ Bed Width 0 Depth 0 ~ <br /> Trench Width 0 Maximum Depth ~ # of rows 0 <br />^ Concrete Maximum Depth 0 Gravel Depth ~ Width 0 <br />^ Fiberglass/Plastic <br />^ Diversion Valve Min. distance between trenches ^ capped ends <br />^ Distribution Box Depth of gravel ~ ^ looped ends ^ Privy ^ Vault <br /> Cubic yards of gravel <br />COMMENTS <br />INSTALL SYSTEM IN ACCORDANCE WITH THE ATTACHED PLAN BY THOMAS A. CRONK P.E. WITH MCHD PLAN <br />APPROVAL STAMP DATED: 7-7-2005 ALLOW 48 HOUR NOTICE FOR FINAL INSPECTION. COORDINATE FINAL <br />INSPECTION WITH RPE AND MCHD. CALL 254-4142 <br />CHANGES TO THE APPROVED PLAN SHALL REQUIRE FURTHER REVIEW <br />