HomeMy WebLinkAbout20072688.tiff • • r
WELD COUNTY HEALTH DEPARTMENT
1555 17th Avenue ' i `1( ( (
c Greeley, Colorado -4014
10i ()0NCKti ' Ph. 353-0540 RECEIPT NOr146 fJ 7'
III
Applicatio r permit t Install, Construct, Alter, or Repair an Individual Sewag sposal System.
OwnOwner40-Ati � Address Phone .2 _/92!
Direction to site /'- 4? all.. 4.4,.,,„_, Legal Description f
G,
General Information Dept. Use Only
No. Bedrooms No. Persons 3- Perc. Rate (Avg. of 3) IS
No. Baths /* Basement Plumbing, — C Soil Type L941`
Size of Lot /SO t4_ Ge )I{,O Table Depth f'
H.LO supply (if well give depth) it-✓ of Grade Vl 5
Type of sewage disposal requested: Requires Engineer Design Yes_ 2(No
Le"-
Septic tank Privy Other If yes reason
Comments:
Installation Instructions:
Septic Tank /000 Gals. Absorption Field 6, O 0 Sq. Ft.
Other Seepage bed WOSq. Ft.
Special Instructions
This system will be constructed and installed in accordance with the above specification and regulations
regarding individual sewage disposal systems in Weld County, Colorado.
This permit shall expire at the same time as the building permit, or, if no building permit is issued, the permit
shall expire 0 days after its issuance, if construction has not been commenced.
Date: 1 2 / / 7/ Owner: ) t ,d—i
Applicant:
The plans d specifications as shown are approved pending payment of permit fee.
Date: tj_ g ' 7 /
Sanitarian: n /Li-
The above system inspected and found to comply with plan and description
Systems Contractor: enl-4$}J -b ! r, Date: /,/ ' 7
Sanitarian a � T ,f C. ; Z-.r.
Engineer Review:
• (Date) (Signature)
reb0
Permit Fee: $
Received by: ate: //— cy ` 2 V
G 2007-2688
• •
'JA, •
L.-,v3E
77)1 -1 -7-# >
Jj. \1:
•
17 '
77
II
77
TOWN OF JOHNSTOWN
101 CHARLOTTE STREET
O.BON 609
J WN,CO 80534 . •
ACCOUNT N DUE DATE
980.127.02 DUE BY 10TH
METER READING
PREVIOUS CURRENT USED 04/25/2007
408 416 8,000 AMOUNT
Payment-Thank you 13.40 CR
Water 67.60
Remember Mothers Day is May 13th
Last Day of School is May 25th •
CURRENT PRIOR TOTAL DUE
67.60 67.60
i
Hello