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7 PERMIT q •Y <br />SAN JUAN BASIN HEALTH UNIT <br />DVRANGD. COLORADO ~X(1~~ `~ <br />3803 No. Main AVe. ., v. •oa .•v /b •c~c~~arc a.+~s+va <br />81301 a•-r•svaa <br />a•y~svv. <br />APPLICATION AND PERMIT TO INSTALL CONSTROCT ALTER. OR REPAIR INDIVIDDAL SENAGB SYSTEM <br />PERMIT EXPIRES 120 DAYS PROM ISSOANCE <br />OWNER OR SPONSOR: <br />MAILING ADDRESS: <br />ADDRESS OF SITE: <br />PARCEL NUMBER: <br />GENERAL INFORMATION: SEPTIC TANK {a'7X <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />• COMMENTS: <br />Gt'SG Sc/~ P ~~P~ yO r <br />a ~C. <br />S~ <br />f~ ro~h clown s'~re~ sides o-Fseca--Q/ <br />L, <br />it/~~/~ii7 .~~Min RP~af~l 7h/'Ok9~ G7r/(/G W~yf /7Qi?~C/hQ Q~*C <br />~ f/1 a.~aw+,, q~'O ~~re~ run o., ~i-~il ~/ sides o-,c P ~a ~e~ wafrv //~ <br />ero~s/~ ~,-f-h 5~1~. ~O uz~ s~e~ c,~~e~si~ eMc%s/~~' S~1, `i <br />~o~z ra~i .Sc~i -S/~~O f~rD//L~~tyf, fie /~/C~'/..~vP.~-f' ovP~ ~,~c~ia.~'. /~ <br />/l~u+'-'uCl,Ka SO / .O~!!t~ .7'~nmJ~EC/! r~.l~J r,~~fo /r1n~oJ/ rl 1 r/~/9c%~ia~ . ~~[/~.. <br />AGREElD'NT: ~ ~~~,r ~j~II S /GS.PJ(tf O ~~IPG'~/1 •r~F!'~ f0 GT//~ /I~r/ODy/O rt v <br />This system ~~~ruc ed in a o/rdanc~ wi~~he a^b/o~ve~/ispecifications and regula- <br />tions go/verni n/g,,i~ndividual sewage dispo11 s''al sy/stems of the /San Juan Basi~n~Hea lath/.. De/pt(J.~/~7 <br />DATE: -7~t~~~7LsL~ APPLICANT: y` C/~~/~•~~"".qG.~p,~/~/l / /I'/ _~ <br />The plc s a ~~d ``s''pe~,cifi~~cations as shown are approved, pending p/ayment/ of fe e <br />INSTALLED BY: SANITARIAN / ~ I •J <br />PERMIT FEE: S ~~ RECEIVED BY LJ~ ~ DATE: I~ I7 ~~ <br />A FINAL INSPECTION IS REODIRED <br />Location of tank/control panel <br />The above system has been inspected and found to comply with the plan and description. <br />n ,~ i <br />Living units ~ ptiCl~r~ iquid capacity /G'L~'~C~: Mat. C/'eiLl~ <br />Number of be rooms ~ <br />Number of bathrooms EXTENDED AERATION: <br />Automatic laundry yr < 1. ity _ <br />Garbage dis oral _~~s__,_. 2. Final tr <br />Lot size ~, 3~~7 +~F'r` subsurface rge <br />water supply b. surface discharge <br />~, ~~~ ~ SOBSORFACH DISPOSAL: <br />Percolation rate ~~ • <br />Soil profile /~ Bed ~{~Lines ~ Length.~6 /t <br />L~.~/- Width /d' Depth~Cover 1 'r t <br />r L <br />Bedrock depth ,~' <br />Wat~ tabl~ept ~~_ GOON. 30" <br />Bottom <br />SANITARIAN: DATE: <br />