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JAN.23.1998 2 :41PM CITY OF ASPEN NO.805 P.24 <br />h _ , <br />AFFIDAVIT <br />(percolation Test) <br />1 kl �, /� , being first duly $worn upon <br />his oath under penalty of perjury, states, avers and certifies as <br />follows: <br />1. That he is the person -,Tho performed the percolation <br />tests as required o4 the reverse hereof. <br />2. That the tests were perforated in accordance with the <br />time schedules and specifications as set forth on the reverse hereof. <br />3. That the test results of the said percolation tests <br />were as set forth on the reverse hereof. <br />4. (In paragraph 4, affiant shall insert additional <br />statements) which may be properly and reasonably required by <br />the Pitkin County Control Officer or the affiant may wish to insert.) <br />J ' <br />f <br />'DATED: 0 4V F rA b F=—. 7— S , 191-!.)-. <br />(Signature 6tMerson Running Test <br />STATE OF <br />Cou= 0�' C L ) S8. <br />SUBSCRIBED AND,SWCRN to before ma this;;�S day of WQVE�h�s <br />-- -My Commission Expires" <br />Rotary, Public <br />NOTE: This affidavit must be returned to the Pitkin County Pollution <br />Control Department within 24 hours of the time the perco�.ation <br />tests are completed (Saturdays and Sundays excepted). <br />