HomeMy WebLinkAboutApplication-Permit.pdfGalfield County Building & Planning Department 108 8th Street Suite 401 Glenwood Springs, CO 81601-Phone: (970)945-8212 Fax: (970)384-3470 Project Address 006636 CR 346 SILT, CO 81652-OWner
Information Antoinette Kuretich Parcel No. 217916102005 Address CO Subdivision permifNQ.SEPT-6,;.10 .. 1595 ".• .. t'eiJ11itTyp~:§~Ptl!:·~~~O)it Woi!<C1Ilssifjcation:Alteratipn .Pem,!(8f"fu's;Acfive
Issue Date: 6/14/2010 Expires: 06/14/2011 Section Township Range GlOMI MINOR SUBDIVISION 16 6 92 Phone CelJ 970-876-0377 Contractor(s) Phone Primary Contractor Required Inspections:
Fo, '",p"tio", "II, 1 (888)868-5306 Proposed Construction I Details Adding on to septic for new home (existing septic tank Valuation: already there). FEES DUE Fee Septic Fee -Alteration
or Repair Total: Amount $73.00 $73.00 Total Sq Feet: FEES PAID Inv Total Pay type Inv # SEPT-6-10-20285 $ 73.00 Check # 3344 $ 0.00 Inspection IVR • 0 Final I 125 Perc Test i 615 --Amt
Paid Amt Due $73.00 $ 0.00 IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE
FOLLOWING: Applicant Copy 1. Final inspection of the work authorized by this permit is required. A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings,
structures and remodeling work. This pennitlplan review expires by time limitation and becomes null and void If the work authorized by the pennit is not commenced within 180 days from
the date of pennit issuance or if the permit is not obtained within 180 days from the date of plan submittal. This pennit expires and becomes null and void if any work authorized by
this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by passing a required County Inspection for a period of 180 consecutive days.
Monday, June 21, 2010 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8~ Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-82 121 Fax: 970-384-3470 /Inspection
Line: 970-384-5003 \V\vw . v...-arfield-countv .com Pa~\1~h~s;~l7\7n~X;i'~ al the assessors office 970-945-9134) ~AtesW~~kss [~~t 3eL~Signed,sYY rOVffi Ct, H~ r~4rame & CiM or and legal
description Lot Si~e: Block No: '2' ur-I)UII Lot N04JtC) sU~'i EXemp\ij WII .101\\, ~ V H1/\ Owner: (property owner) Mailing Address Ph: Alt Ph: flo)J -\rn lfp ~~ Arj ) ~I b L.(}JAI
H VJ ·1'111 SI l~ W ~Ibl\~ ~ ontrador: OMailing Address ~I (,{h Ph: Alt Ph: 1 .• ) Cj lll)k'"\i~" 1.0 1'\0 llb:fl G\MIl1:~ <.Ct.S (fJ 47o ' ) ICd~U ngineer: Mailing Address "-Ph: All
Ph: PERMIT REQUEST FOR: {-'( New Installation ( ) Alteration ( ) Repair WASTE TYPE: ( )Dwelling ( )Transient Use ( )Commercial or industrial ( )Non-Domestic wastes ( )Other -Describe
BUILDING OR SERVICE TYPE: Pn\> I.."., Number of bedrooms S Garbage Grinder ( )Yes filNo SOURCE & TYPE OF WATER SUPPLY: (",-WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN If supplied by
COMMUNITY WATER, give name of suppliec DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: '-\ hi,,,, Was an effort made to connect to the Community System? ~o YOUR INDIVIDUAL SEWAGE DISPOSAL
SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND CONDITIONS: Depth 10 1" Ground Water Table Percent Ground Slope ~ OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (1505) PROPOSED: (
eptic Tank ( )Aeration Plant ( )Vaull ( )Vault Privy ( )Composting T oilel ( )Recycling, Potable Use ()Recycling, other use ()Pit Privy ( )Incineration Toilet ( )Chemical Toilet ( iOlher-Describe
FINAL DISPOSAL BY: (i Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Waslewater pond ( )Other-Describe Will
effluent be discharged directly into waters of the state? ( )YES r O PERC::JY)!JN TEST RESULT: 1'0 be compleled by Registered Pro'essional Eogioeer, ilthe Eo,ioeer does the Pe~olaiion
Test) ~ Minutes per inch in hole No.1 Minutes per inch in hole No.3 Minutes per inch in hole No.2 Minutes per inch in hole No._ Name, address & telephone of RPE who made soil absorption
test: Name, address & telephone of RPE responsible for design of the system: Applicant acknowledges that the completeness of the application is conditional upon such fu rther mandatory
and additional test and reports as may be required by the local health department to be made and furnished by the applicant or by the local health department for purposed of the evaluation
of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations made, information and reports
submitted herewith and required to be submitted by the applicant are or will be represented to be true and correct to the best of my knowledge and belief and are designed to be relied
on by the local department of health in evaluating the same for purposes of issuing the permit appJied for herein. I further understand that any falsification or misrepresentation may
result in the denial of the application or revocation of any permit granted based upon said application at1:egal action for perjury as provided by law. (0 11.4 /() IrWW --OWNERS SIGNATURE
DATE ~ 1011~ l lOC~3344 STAFF USE ONLY Permit Fee: \ Perk Fee: Total fees: Building Permit #: l~ Co --i 3,C:lO 159L{ Septic Permit #s Lo-IO-I51:5 Issue Date: . cPT-U ILl 10 rT7j}la~~
)gy,, _ Lo 14 10 APPI/.O AL DATE V
Garfield County Inspection History Building & Planning Department 108 8th Street Suite 401 Glenwood Springs, CO 81601-Phone: (970)945-8212 Fax: (970)384-3470 Permit Number: SEPT-6-10-1595
Project: <NONE> Owner: Antoinette Kuretich Contractor: A.J. Construction Phone: 970-876-0377 PO Box 1671 Email: Glenwood Springs, CO 81602 Job Address: 006636 CR 346 SILT, CO 81652 Parcel:
217916102005 Scheduled Insp# Inspection Type Inspection Status Inspector Date Completed 06/23/2010 INSP-8022 Final Passed Dave Mead 6/23/2010 Wednesday, November 3,2010 Page 1 of 1