HomeMy WebLinkAboutApplication-Permit.pdfGarfield County Building & Planning Department 108 8th Street Suite 401 Glenwood Springs, CO 81601-Phone: (970)945-8212 Fax: (970)384-3470 Issue Date: Not Issued Expires: 01/01/2999
Project Address 6768 CR 331 RD SILT, CO Owner Information James Knight Contractor/s) Golden Villa Homes Proposed Construction I Details FEES DUE Fee Percolation Test Septic Fee -New
Total: Thursday, July 1, 2010 Parcel No. Subdivision Section Township Range 240110300088 Address Phone Cell 620251/2 RD Grand Junction CO 81505 970-640-9684 Phone Primary Contractor
Required Inspections: (970)245-9039 Yes For Inspections call: 1 (888)868~5306 Inspection IVR Valuation: $ 0.00 Total Sq Feet: o See Permit Record FEES PAID Amount 111\1 Total·· .• Paytype
.•.... ·Amt Paid AmtDue $100.00 $73.00 $173.00 Inv # SEPT-6-10-20310 $ 173.00 Check # 54173 $173.00 $ 0.00 Building Department Copy 2
I 2 3 4 5 6 7 8 9 to II GARFIELD COUNTY SEPTIC PERMIT APPLICA nON 108 8~ Street, Suite 40 1, Glenwood Springs, Co 81601 Phone: 970-945-8212/Fax: 970-384-3470 /Inspection Line: 970-384-5003
www.garfield·cDuntv.com parce~NtXlh~nf\ation~ ~~i!~ al th~SDSO O~~70-945-91341 Job ~d~etS~if an rd:Rhas ~ ~ a\ signed, Ple~ ~\t Hwy or Street Name & City) or and legal description Lol
Sizel \ . Lol No: Block No: Subd./Exemption: <u:--Q.L-5 Owner: (property owner) Mailing Address Ph: '3'~'M~'" t'~~c."-l 1.'4. 2-S~ R-u (ytl.-• .J.<r.t, Woe; q,o -tp 4o-'{",~</Coe actf
l ; \ \ ~ ., <1-", J \ II 0 ""'"h Mailing Address I 2 ~ 1 S t+wv l. f-.s~O Ph: ~ , .I.;' 'nD·) L) ,-qo:; q Engineer: Mailing Address Ph: PERMIT REQUEST FOR: (~ New Installation ( ) Alteration
WASTE TYPE: (--\!Dwelling ( )T ransient Use ( )Commercial or industrial ( )Olher Describe BUILDING OR SERVICE TYPE: Number of bedrooms 2 Garbage Grinder ( )Yes SOURCE & TYPE OF WATER
SUPPLY: ('I)WELL ( )SPRING ( )STREAM OR CREEK If supplied by COMMUNITY WATER, give name of supplier DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an eHort made to connect to the Community
System? All Ph: All Ph: 970 23~-< IiY," All Ph: ( ) Repair ( )Non-Domestic wastes ()t)No ( )CISTERN YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12 GROUND CONDITIONS: Depth-to 1st Ground Water Table T Q:. t::> Percent Ground Slope -<' 2-13 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (1505) PROPOSED: (,A.)Seplic Tank ( )Aeralian
Plant ( )Vaull ( )Vaull Privy ( )Composting Toilet ( )Recycling, Potable Use i iOlher-Describe ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical T oilel 14 FINAL
DISPOSAL BY: (.{)Absorplion Irench, Bed or Pil ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filler ( )Waslewaler pond ( )Other-Describe 15 Will effluent
be di scharged directly into waters of the state? ( )YES (,kjNO 16 PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolalion
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: 17 Applicant acknowledges that the completeness of the application is conditional upon such further mandatory
and addilionallest and reports as may be requ ired 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 \0 such terms and conditions as deemed necessary 10 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 10 Ihe 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 applied 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 and legal "C(n i\2lury as providew by law~ .. k it G 1-I..n ,,,\,,, N'n . ....
.J -~ -\ () OWNERS SIGNATURE (~ DATE STAFF USE ONLY Permit Fee: Perk Fee: Total fees: Building Permit #: 1-3 ilDC> \1-3 -\ laDI Septic Permit #:~\J\ Issue Date: -\~ 6/~//"" Building
& Planning Dept: ~~ 6/.zW~ APPROVAL DATE
Inspection History Permit Number: SEPT -6-10-1608 Owner: Phone: Email: Job Address: Parcel: Scheduled 07/26/2010 07/08/2010 James Knight 970-640-9684 6768 CR 331 SILT, CO 240110300088
Insp# INSP-8131 INSP-8132 Tuesday, November 23,2010 Inspection Type Final Perc Test Garfield County Building & Planning Department 108 8th Street Suite 401 Glenwood Springs, CO 81601-Phone:
(970)945-8212 Fax: (970)384-3470 Project: <NONE> Contractor: Golden Villa Homes co Inspection Status Inspector Passed Dave Mead Passed Matt Provost Date Completed 7/26/2010 7/8/2010
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