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Scanning Cover Sheet
for
Septic Permits
Permit #
Permit Type:
G19750606
9750606
Health / EHS History / EHS Conversion History
Situs Street Address 5346 FIR Av
Situs City, State, Zip
Sec/Town/Range: 05 -01N -68W Application Status: Fineled
Application Date: 03/11/1996
Parcel # digits) 146705402006-R5683286
Owner Full Name:
Owner Address:
Contact Name:
Contact Address:
BROWN BOB
BOX 837
LONGMONT,CO 80501
Owner Phone #: 303 8283066
Contact Phone#
Information above has been Verified in Acoela b errs to ee noted .below
X '1J'allA"`2-17
Processed by:
February 25, 2009
Date
Report ID: EHS00024v003 Page 1 of 1
Print Date -Time: 2/25/2009 1:34:07PM
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WELD COUNTY HEALTH DEPARTMENT
1555 17th Avenue
Greeley, Colorado
Ph. 353-0540
'1 S 0(0 Up
RECEIPT NO.`
Application fo ermit to Install, Construct, Alter, or Repair an Individual Sewa r isposal System. Owner, fJ # ddress _ Phone �"3e:2�6/
Direction to site / ,,,� Legal Description./ /rs - ,j4-3
General Information
No. Bedrooms No. Persons
No. Baths Basement Plumbing
Size of Lot
H:0 supply (if well give depth)
Type of sewage disposar requested
Septic tank Y Privy Other
F"fK 4v
Installation Instructions:
Septic Tank
• 1OOO
Gals.
Other
Dept. Use Only
Pere. Rate (Avg, of 3) )�s�C�} r2O a
Soil Type ),-1" l>va wo
H.,O Table Depth
Lot Grade
Requires Engineer Design Ye
If yes — reason
Comments:
T"ere-g-1CA
Absorption "mil 148—
ir" Sq. Ft.
Seepage bed gq0 S'q, 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 sanse time as the building permit, or, if no building permit is issued, the permit
shall expire 120 days after its issuance, if construction has not been co winced.
Date:
Owner:
Applicant: _
The plans and specifications as shown are approved pending payment of ptmit fee.
Date:
Sanitari'
The above system inspected and found to comply with plan and description.
Systems Contractor: 1...164._121-,�1r5ovJ Date:
Sanitaria
Engineer Review:
Permit Fee:
Received by:
(Date)
(Signature)
Date
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