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 Project Address Parcel No. SUbdivision 216921400026
DEBEQUE,CO Owner Information Address OXY USA WTP LP 760 Horizon DR Grand Junction CO 81506 PermitNO.BLCO·7~10,.1630 .. ' pemlitTYfJ~:C~lTllTIl!rcj~l~uil~i'1~ . ". WorkClassi/ioation:
Ne.w • . '>PefTlliISlatus:'ACfive Issue Dale: 12/1/2010 Expires: 05/30/2011 Section Township Range Phone Cell Contractor{s I Phone Primary Contractor Required Inspections: Proposed Construction
I Details Minor temporary employee housing at well pad 697-16-16 FEES DUE FEESPAfD Valuation: Total Sq Feet: $ 40,716.00 4524 Fee Amount InvTotal Paytype Amt Paid Amt Due Commercial
Building Fee Manufacture Fee Plan Check Fee Total: Wednesday, December 1,2010 $552.85 $600.00 $359.35 $1,512.20 Inv # BLCQ·7·10·20347 $ 1,512.20 Cred;1 Card Credit Card $600.00 $912.20
$ 0.00 F .. 'osp"lfo", ",,: 1 (888)868-5306 Inspection IVR See Permit Record Building Department Copy 2
I 2 3 4 5 6 7 8 9 10 II 12 GARFIELD COUNTY BUILDING PERMTT APPUCA nON 108 glh Street, Suite 401 , Glenwood Springs, Co 81601 Phone: 970-945-82 12/Fax: 970-384-3470 /Inspection Line:
970-384-5003 www.garlield-counl y.com P arcel No: (this informatiun is available al the assessors office 970-945-91 34) 2169-214-00026 J ob Address: (ifan address has not been assigned,
please provide Cr, Hwy Of Street Name & City) or and legal description 697-16-16 Well Pad Location -NE 1/4 Sec 16 T6S R97W LotNa: N/A Block No: N/A Subd.l Exemption: Owner: (properly
owner) Mailing Address: Ph : OXV USA WTP LP 760 Horizon Dr, Suite 101 Grand Junction, Co 81506 970-263-3637 Contractor: Mailing Address: Ph; Architect /Engineer: Mailing Address: Ph:
Sq. FI. orBuilding: 6 Units = 4524 Total Sq. Ft. or Acres of Lot N/A 71'?2... Height: 10 ft. Use of Building: As per GARee Temporary housing permit,temporary housing on eeGee permitting
site Describe Work: Prefabricated modular setup at the above location Class of Work: 0New o Alteration 0 Addition Garage: N/A Septic: o Attached 0 Detached IZlTSDS Driveway Permit: Exempted
per Jake Mall Owners valuation of Work: $ NOTICE N/A AI! Ph; 970-412-2776 AI! Ph: AI! Ph: No. of Floors: 1 o Community 337852.32 Authority. TIlis application for a Building Pcrmit must
bc signcd by the Owner oflhe propcrty, describcd above, or an authorized agent. If the signature below is not that of the Owncr, a scparatc letter of authority, signcd by thc Owner,
must be provided with this Application Legal Access. A Iluilding Pennil cannot be issucd without proof of legal and :ldequale access to thc property for purposes of inspections by the
Building Dcpartmcnt. Olher Permits. Multiple separate permits may be required: (I) Statc Electrical Permit, (2) County ISDS Pennit, (3) another pennit required for use on the property
identified above, e.g. State or County Highwayl Road Acecss or a State Wastewater Discharge Permit. Void Permit A Building Pennit becomes null and void if the work authorized is not
commenced within 180 days of the datc of issuance and if work is suspendcd or abandoncd for a pcriod of 180 days after commeneemcnt. CERTIFICATION I hereby certi fy that I have read
this Application and thatlhe information contained above is true and eorrec\. I understand that the Building Department accepts the Application, :llong with the plans and ~pecirkations
and other data submitted by me or on my behalf (submittals). based upun my certification as to accuracy. Assuming e011lpletenes~ of the submittals and approval of this Application, a
Building Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the Building Department. In consideration
of the issuance of the Building Permit, I agree that I and my agents will comply with provisions of any fedeml, state or local law regulating the work and the Garfield County Building
Code. ISDS regulations and applicable land usc regulations (County Regulation(s». I acknowledge that the Building Permit may be suspendcd or revoked, upon notice from the County. if
the location, construction or use of the strueture(s) and facility(ies), describcd above, arc not in compliance with County Regulation(s) ur any other applicable law. I hereby gmnt pennission
to the Building Department to enter the property, described above, to inspect the work . I further acknowledge that the issuance of the Building Pcrmit does not prevent the Building
Official from: (I) requiring the currection of errors in the submittals, ir any, discovered after issuance; or (2) stopping construction or use of the structure(s) or facility(ies) if
such is in violation of County Regulation(s) or any other applicable law. Review of this Application, including submittals. and inspections of the work by the Building Department do
not constitute an acceptance of responsibility or liability by the County or errors. omissions or discrepancies. As the Owner, I acknowledge that responsibility for compliance with fed
eral, sla te and local laws and County Regulations rest with me and my authorized agents, including without limitation my architect designer, engineer and! or builder. I HEREBY ACKNOWLEDGE
THAT I H~€lr AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE, -==-~ );2 , ~· ILQ) OWNERS STGNATUREr-DAT~ 7 STAFF USE ONLY Special Conditions: Adjusted Valuation: Plan Check Fee: Permit
Fee: Manu home Fee: Misc Fees: '-1°1 ( lb. OD 359. '35' Ssz. 8~ 600.00 ISDS Fee: Total Fees: Fees Paid: Balance Due: BP No & Issue Date: ISDS No & Issued Date: ,3.°0 15/2.'2.0 loCO .o
O 912. zo \ 1.t>W'L.c.o ILo~1 Setbacks: acc Group: Const Type: Zoning: , 1 I /£2.2-J.lB 12L oc) ~ 10C;) loa BLDG DEPT: PLNG DEPT: . ~'Rtf:t:r~DAT:~:"f~ ~~6~" I /0-0 , ; APPROVAL DATE
The following items are required by Garfield County for a tinal Inspection: I) A final Electricallnspection from the Colorado State Electrical Inspector. 2) Permanent address assigned
by Garfield County Building Department and posted at the structure and where readily visible from access road. 3) A finished roof; a lockable building; completed exterior siding; exterior
doors and windows installed; a complete kitchen witb cabinets, sink with hot & cold rU1llling water, non-absorbent kitcben floor covering, counter tops and finished walls, ready for
stove and refrigerator; all necessaty plumbing. 4) All bathrooms must be complete, with washbowl, tub or shower, toilet, hot and cold running water, non-absorbent floors, walls finished,
and privacy door. 5) Steps over three (3) risers, outside or inside must be must have handrails. Balconies and decks over 30" high must he constructed to alllBC and IRC requirements
including guardrails. 6) Outside grading completed so that water slopes away from the building; 7) Exceptions to the outside steps, decks, grading may be made upon the demonstration
of extenuating circumstances., i.e. weather. Under such circumstances A Celtificate of Occupancy may be issued conditionally. 8) A final inspection sign offby the Garfield County Road
& Bridge Department for driveway installation, where applicable; as well as any final sign off by the Fire District, and/or State Agencies where applicable. A CERTIFICATE OF OCCUPANCY
(e.O.) WILL NOT BE ISSUED UNTIL ALL THE ABOVE ITEMS HAVE BEEN COMPLETED. A e.O. MAY TAKE UP TO 5 BUSINESS DAYS TO BE PROCESSED AND ISSUED. OWNER CANNOT OCCUPY OR USE DWELLING UNTIL A
e.O. IS ISSUED. OCCUPANCY OR USE OF DWELLING WITHOUT A e.O. WILL BE CONSIDERED AN ILLEGAL OCCUPANCY AND MAYBE GROUNDS FOR V ACA TlNG PREMISES UNTIL ABOVE CONDITIONS ARE MET. I understand
and agree to abide by tbe above conditions for occupancy, use and the issuance of a e.o. for the building identified in the Building Permit. OWNERS SIGNATURE Bappiicaliondecember2007
Building Plan Review Description of Work: Minor temporary employee housing at well pad 697-16-16 Bin#: Location Address: DEBEQUE,CO Case Manager: David Bartholomew Plan Case Number:
BLDG-7-10-6498 Parcel: 216921400026 Application Date: 07/07/20 I 0 ___/_ __' Engineered Foundation __)-'1.r..._',A:-:-_DriVeWay Permit /___ + _Surveyed Site Plan 7 ' ___ ,.-_,Septic
Permit and Setbacks /_____ G,radefTopography 30% _---~,lf_l-l-_Attach Residential Plan Review List ___/_ __ Minimum Application Questionnare /' _____ ,Subdivision Plat Notes __ /--:-_Fire
Department Review __ /"'7"_V,aluation Determination/Fees 7 ___ -;-_Red Line Plans/Stamps/Sticker /__ ~<--_.Attach Conditions 7 c __ --,_~Application Signed 7 ___ .,--_Plan Reviewer To
Sign Application _-,-/___ ,parcel/schedule No_ _ /____ -40# Snowload Letter -Manu, Homes _ t-Jf-,:.t;-'f--__,s OiIS Report Contacts Owner: OXY USA WfP LP Applicant: OXY USA WfP LP Applicant
Phone: Email: PlanninglZoning /__ ----,,.-_'Property Line Setbacks /__ --,_---:30ft Stream Setbacks 7 __ ----,_-,Flood Plain 7 __/_ .,.-_IBuilding height _____ ~Z'oning Sign-off __~~
1~,-1'-_IRoadlmpactFees _c../.!..!.10.,c.J:# _I HOAlDRC Approval /_____ ,GradefTopography 40% /___/---cr-_IPlanning Issues -----:Subdivision Plat VA!UAIw j?eh?tll f2>e jZwlCW I'e<e /H~xl:fre-General
Comments: ,/0, 1/b.oo .3'.5z.85 359.5f 600. ()D 70?'?1-L-//' .5/z., Z-0 ~.;.. ~lcI_~b=-O_l~~c C>O_ _ 9/2.20
VALUATION FEE DETERMINATION Applicant Address Date ..:O::.:X-,:Y.:..,,::U,-,S::..A:.,WTP~..:.,..:L:::P _______ Subdivision Wen Pad 697-16-16 Lot/Block -:1C:-1/7.1~6'/::2;::0':'1O~~=:"--------Contract
or Finished <Livable Area): Main Upper Lower Other Total Basement: Unfinished Square Feet Valuation Conversion of Unfinished to Finished Total Valuation Garage/Storage (wood framed)
Carport: Total Crawl Space Total Valuation Valuation Decks/PatioslPorches Covered Open Total Valuation Type of Construction: Occupancy: Valuation Total Valuation sq.h sq.h sq.h sq.h
X $74.68 o sq.1t sq.ft X $41.00 sq.ft X $33.68 sq.ft X $18.00 sq.ftX $12.00 4524 sq.ft X $9.00 Commercial sq.ft X $24.00 sq.ftX $12.00 sf X sf X sf X sf X sf X sf X N/A N/A Owner 0.00
40,716.00 0.00 0.00 40,716.00
GARFIELD COUNTY BUILDING AND PLANNING 970-945-8212 MINIMUM APPLICATION REQUIREMENTS For MANUFACTURED HOMES In order to understand the scope of the work intended under a pelmit application
and expedite the issuance of a pelmit it is important that complete information be provided. When reviewing a plan and it's discovered that required information has not been provided
by the applicant, this will result in the delay of the permit issuance and in proceeding with building construction. The owner or contractor shall be required to provide this information
before the plan review can proceed. Other plans that are in line for review may be given attention before the new infonnation may be reviewed after it has been provided to the Building
Department. Please review this document to determine if you have enough information to design your project and provide adequate information to facilitate a plan review. Also, please
consider using a design professional for assistance in your design and a construction professional for construction of your project. To provide for a more understandable plan in order
to determine compliance with the building, plumbing and mechanical codes, applicants are requested to review the following checklist prior to and during design. Applicants are required
to indicate appropriately and to submit the completed checklist at time of application for a permit. All plans submitted must be incompliance with the 2003 IRC for Residences and 2003
IBC for Commercial Offices and Storage. I
1. Is a site plan inclnded that identifies the location of the proposed structnre or addition and distances to the property lines from each corner of the proposed structme prepared by
a licensed smveyor and has the snrveyors signatnre and professional stamp on the drawing? Properties with slopes of 30% or more must be shown on site plan. (NOTE Section 106.2) Any site
plan for the placement of any portion of a structnre within 50 ft. of a property line and not within a previously smveyed building envelope on a subdivision final plat shall be prepared
by a licensed smveyor and have the smveyor's signature and professional stamp on the drawing. Any structnrc to be built within a building envelope of a lot shown on a recorded subdivision
plat shall include a copy of the building envelope as it is shown on the final plat with the proposed structme located within the envelope. Yes X .~----2. Does the site plan when applicable
include the location of the 1.S.D.S. (Individual Sewage Disposal System) and the distances to the property lines, wells (on subject property and adjacent properties), streams or water
comses? This information must be certified by a licensed smveyor with their signatme and professional stamp on the design. Yes X ~----3. Does the site plan include any other buildings,
setback easements and utility easements? Please refer to Section 5.05.03 in the Garfield County Zoning Resolution if the property you are applying for a building permit on is located
on a corner lot. Special setbacks do apply. Yes X 4. Does the site plan indicate the location and direction of the County or private road accessing the property? Yes X 5. Do the plans
include a foundation plan indicating the size, location and spacing of all reinforcing steel in accordance with the uniform building code or per stamped engineered design? A Floor Plan
of the Modular Unit showing exterior doors is required. Yes X 6. Do you understand that if you belong to a homeowners association, it is yom responsibility to obtain written pelmission
from the association, if required by that association, prior to submitting an application for a building permit? The building permit application will not be accepted without it. Yes
X No __ ~~~_ 7. Will this be the only residential structnre on the parcel? Yes X No Ifno-Explain: ___ ~~_ 8. Have two (2) complete sets of construction drawings been submitted with the
application? Yes X 2
9. For the placement of a mannfactured home, have the following been specified? The size of the unit (min. 20ft. x 20ft.); live roofload (min. 40# could be more depending on elcvation
of property); wind design (min. wind speed of 90 mph); foundation design; method of anchoring? Yes X 10. I·Iave you designed or had this plan designed while considering building and
other constmction code requirements? Yes X 11. Do your plans comply with all zoning mles and regulations in thc County related to your zonc district? Yes X 12. Docs the plan accurately
indicate what you intend to constmct and what will receive a final inspection by the Garfield County Building Department? Yes X 13. Do you understand that approval for design and/or
constmction changes are required prior to the application of these changes? Yes X 14. Do you nnderstand that the Building Department will collect a "Plan Review" fee from you at the
time of application and that you will be required to pay the "Permit Fee" as well as any "Road Impact" or "Septic System" fees required, at the time you pick up your building permit?
Yes x 15. Are you aware that you must call in for an inspection by 3:30 the business day before the requested inspection in order to receive it the following business day? Inspections
will be made between 7:30 a.m. and 3:30 p.m. Monday through Friday. Inspections are to be called in to 384-5003. Yes X 16. Are you aware that requesting inspections on work that is not
ready or not accessible will result in a $50.00 re-inspection fee? Yes X 17. Are you aware that you are required to call for all inspections required under the IRC including approval
on a final inspection prior to receiving a Certificate of Occupancy and occupancy of the building? Yes X 3
18. Are you aware that prior to as submittal for a building permit application you are required to show proof of a legal and adequate access to the site? This may include (but is not
limited to) proof of your right to use a privatelright of way; a County Road and Bridge permit; a Colorado Dept. of Highway Permit including a Notice to Proceed; a permit from the federal
government or any combination. You can contact the Garfield County Road & Bridge Department at 625-860 I See phone directOlY for other agencies. Yes X 19. Do you understand that you
will be required to hire a State of Colorado Licensed Electrician and Plumber to perfonn installations and hookups, unless you as the homeowner are performing the work? The license number
of the person perfonning the work will be required at time of applicable inspection. Yes X 20. Are you aware, that on the front of the Building Permit Application you will need to fill
in the Parcel/Schedule Number for the lot you are applying for this permit on prior to the submittal of a building permit application? Your attention in this is appreciated. Yes X 21.
Are you aware that you will need to have your installer obtain an installation inspection as per the State Division of Housing requirements prior to the County building depaliment doing
their final inspection? The State will charge a fee for this inspection. Yes X 22. Are you aware that the Pennit Application must be signed by the Owner or a written authority being
given for an Agent and that the party responsible for the project must comply with the Uniform Building Code? Yes_x_ __ 23. Are you aware, that if you receive your water and/or sewer
from an Association, a District or Municipality, you will be required to provide the County with a copy of the Tap Pennit (or evidence of an exemption) at the time of the building pennit
application submittal? Yes X ---24. Do you understand that if you are planning on doing any excavating or grading to the property prior to issuance of a building permit that you will
be required to obtain a grading pennit? Yes -X---4
I hereby aclmowledge that I have read, understand and answered these questions to the best of my ability. Signature of Owner Phone: 970·263·3637 or 970-412-2776 (days); _ _ ___ _____
(evenings) Project Name: 697·16·16 Temporary Employee Housing Project Address: 697·16·16 Well Pad Location · NE 1/4 Sec 16 T6S R97W Notes: If any required information is missing delays
in issuing the pelmit are to be expected. Work may not proceed without the issuance of a permit. If it is detennined by the Building Official that additional information is necessary
to review the application and plans to determine minimum compliance with the adopted codes, the application may be placed behind more recent applications for building permits in the
review process and not reviewed unti I required information has been provided and the application rotates again to first position for review, delay in issuance of the permit or delay
in proceeding with construction. bpminreqmhDec2007 5
Account Account: R290047 Location Parcel Number 2169-214-00-026 Situs Address City Debeque Zi pCode 81630 Tax Area 029 -J-49HBDF -029 Legal Summary Section: 21 Township: 6 Range: 97
SEC. 4 LOTS 9(40A) 16(40A) W1/2SW SEC. 5 LOTS 5 (40. 14A)6 (40.03A)7(39.91A)8(E 1.62A)9 (40A) 1 0(40 A) 11(40A) 12(40A) 13(40A) 14(40A) 15(40A) 16 (40A) S1/2 SEC. 6 LOTS 14 (E1/2 20A)
15(40A) 16(40A) 17 (E1/2 20A) E1/2W1/2SE, E1/2SE SEC8 E1/2, E1/2W1/2, SWNW, W1/2SW SEC 9 ALL SEC 15 ALL SEC 16 ALL SEC. 17 ALL SEC. 18 E1/2, SENW SEC. 19 NE, E1/2NW, E1/2W1/2NW, THAT
PT OF SESE LYING BELOW THE MAHG. MKR(NET 14.76A) SEC 20 ALL SEC 21 ALL SEC 22 ALL SEC. 28 N1/2, THAT PT OF THE S1/2 LYING ABOVE THE MAHG. MKR(NET 165.4A) SEC. 29 ALL SEC. 30 THAT PT
OF THE E1/2 & SW LYING BELOW THE MAHG.MKR(NET 151 .84A) SEC 31 THAT PT OF LOTS 5,6,7 LYING BELOW THE MAHG. MKR(NET 117.73A) SEC32 LOTS 1 (54.85A) 2(54. 85A) 3(54.87A) 4(54.87A) SEC.
33 THAT PT OF LOTS 3 LYING ABOVE THE MAHG. MKR (NET80.27A) SEC. 4-7-97 THAT PT OF TRS 78,79,80&81 LYING ABOVE MAHG. MKR. (42.7A) SEC. 5 THAT PT OF TRS 80 (125A2A) 81(130A) LYING IN SEC.
5 TR 82(80.05A) 83(80A) SEC. 6 TR 84 (160A) 85(160A) 86(152.97A) 87(153.73A) SEC7 TR 88 (160A) 89(160A) 90 (153.63A) 91(153.73A) AKA PT OF TRIUMPH 47, PT OF DENVER MINING CLAIMS 3,4,5,6,
PT OF DERE 2,3,5,6 DENVER 43,44, PT OF DENVER 42,111, 112 DENVER 45-52 Transfers Sale Price Owner Information Owner Name OXY USA INC In Care Of Name PROP TAX DEPT Assessment History
Actual (2010) Primary Taxable Page 1 of 2 $974,460 $282,590 Tax Area: 029 Mill Levy: 28.6170 Owner Address PO BOX 27570 Type Actual Assessed Acres Units HOUSTON, TX 77227-7570 Improvement
$501,790 $145,520 1.000 Sale Date 04105/2010 03/10/2010 Land $472,670 $137,070 10303.370 Doc Type 300 300 Book Page https:llactgarfield-county. com/assessor/taxweb/account.jsp ?accountN
um= R29004 7 7/8/201 0
Account Tax History Tax Year Taxes 01/15/2010 10/27/2009 Images • GIS '2010 $8,086.88 ,--..,..,--,..--=r==,,----,--==r==t 2009 $8,086.88 '" Estimated o Page 2 of 2 https :llact.garfield-county
.com/assessor/taxweb/account.jsp ?accountN um= R29004 7 7/8/201 0
David Bartholomew From: Sent: To: Subject: Molly, Craig_Richardson@oxy.com Tuesday, November 30, 20101:41 PM Molly Orkild-Larson; David Bartholomew MTEH 6497 Building Permits Is everything
good to go? Can Dave issue the building permit? Thanks, Craig From: Molly Orkild-Larson [mailto:morkild-Iarson@garfield-countv.com] Sent: Friday, November 12, 2010 12: 13 PM To: Richardson,
Craig D; Padilla, Daniel Subject: MTEH 6497 TC Letter and Director's Determination Daniel and Craig: Please find attached the technically complete letter and the Director's Determination.
The 14 days call up period ends November 26th A hard copy is coming in the mail to Daniel. Please call if you have any questions. Thanks, Molly 1
ADMINISTRATIVE PERMIT MTEH 7-10-6497 for One Minor Temporary Employee Housing Facility located on property owned by OXY USA WPT LP on a natural gas well pad described as 697-16-16D withAPD
#20065330 Parcel Number: 2169-214-00-026 In accordance with and pursuant to the Garfield County Land Use Resolution of 2008, as amended, of the Board of County Commissioners of Garfield
County, State of Colorado, the Director of the Building and Planning Department hereby authorizes, by Administrative Permit, the following activity: The installation of one Minor Temporary
Employee Housing Facility located in NW114 of Section 16, Township 6 South, Range 97 West. The Administrative Permit is issued subject to the conditions set forth in Exhibit A (attached
hereto), and shall be valid only during compliance with such conditions and other applicable provisions of the Garfield County Zoning Resolution, Subdivision Regulations, Building Code,
and other regulations of the Board of County Commissioners of Garfield County, Colorado. BUILDING AND PLANNING DEPARTMENT, GARFIELD COUNTY, COLORADO \&;~,Jli'<f!Tn,;,,4i;( /J~ 50-10
Dir r Date
David Bartholomew From: Sent: To: Subject: Attachments: Craig_Richardson@oxy.com Tuesday, November 16, 2010 9:01 AM David Bartholomew RE: MTEH 6497 TC Letter and Director's Determination
Tie-down calcs.pdf Sorry for not including this in the packet. Let me know if you have any questions. Thanks, Craig From: David Bartholomew [mailto:dbartholomew@garfield-county.coml
Sent: Tuesday, November 16, 2010 8:54 AM To: Richardson, Craig 0 Cc: Andy Schwaller; Molly Orkild-Larson; Fred Jarman Subject: RE: MTEH 6497 TC Letter and Director's Determination Craig,
I just went thru the plans, I still need stamped structural's for the foundation/anchoring of the units. As soon as I receive the structural's and a copy of Fred's signed determination
letter, I'll forward the permit for issuance. Thanks, DB From: Craig Richardson@oxv.com [mailto:Craig Richardson@oxv.coml Sent: Friday, November 12, 2010 1:04 PM To: David Bartholomew
Subject: FW: MTEH 6497 TC Letter and Director's Determination Dave, Molly issued the TC letter and Director's determination today for the 697-16-16 well pad. Our call up periods ends
on the 26th. Do you have everything needed to issued the building and septic permits on this date? Let me know if you need anything from our office. Thanks, Craig From: Molly Orkild-Larson
[mailto:morkild-Iarson@qarfield-county.coml Sent: Friday, November 12, 2010 12: 13 PM To: Richardson, Craig 0; Padilla, Daniel Subject: MTEH 6497 TC Letter and Director's Determination
Daniel and Craig: Please find attached the technically complete letter and the Director's Determination. The 14 days call up period ends November 26th• A hard copy is coming in the mail
to Daniel. 1
Please call if you have any questions. Thanks, Molly 2
November 12, 2010 Attention: Mr. Daniel Padilla OXy USA WTP LP 743 Horizon Ct. Grand Junction, CO 81506 Garfield County BUILDING & PLANNING DEPARTMENT RE: MTEH 3·10·6497 -Minor Temporary
Employee Housing -Oxy USA WTP LP Dear Mr. Padilla: This office is in receipt of an Application for a Minor Temporary Employee Housing Facility operated by Oxy USA WTP LP in the Resource
Lands -Plateau Zone District. The Administrative Permit requested is for a property owned by Oxy USA WTP LP and is to be located on a well pad described by APD 20065330 (697-16-16D).
The subject parcel is described by tax ID 2169-214-00-026. This letter is to inform you that the application has been deemed technically complete. Please be advised that as of the date
of this letter, the Planning Directpr has up to 14 calendar days to make a determination of approval, approval with conditions or denial. Once a determination has been made, a 14 calendar
day call-up period III required per Article IV, Section 4-108 (A) (2) before the determination becomes final. The call-up period allows the Board of County Commissioners, neighboring
property owners, the surface estate owner, the Applicant or the mineral estate owner the right to dispute the determination of the Director. Should you have additional questions, do
not hesitate to contact this office. Sincerely, 970.625.5903 0375 County Road 352, Building #2060 • Rifle, CO 81650 (970) 625-5900' Fax: (970)625-5939 108 Eighth Street, Suite.401 •
Glenwood Springs, C081601 (970) 945-8212' Fax: (970) 384-3470 .
November 12, 2010 Attention: Mr. Daniel Padilla OXY USA WTP LP 743 Horizon Ct. Grand Junction, CO 81506 Garfield County BUILDING & PLANNING DEPARTMENT RE: MTEH 3-10-6497 -Minor Temporary
Employee Housing -Oxy USA WTP LP Dear Mr. Padilla: This office is in receipt of an Application for a Minor Temporary Employee Housing Facility operated by Oxy USA WTP LP in the Resource
Lands -Plateau Zone District. The Administrative Permit requested is for a property owned by Oxy USA WTP LP and is to be located on a well pad described by APD 20065330 (697-16-16D).
The subject parcel is described by tax ID 2169-214-00-026. More specifically, the Applicant requests approval for one Minor Temporary Employee Housing facility to house 9 to 24 personnel
for the purpose of natural gas drilling operations. The Applicant has represented that the facility will be on-site for less than one year, will have water hauled to the site and a vauit-and-haul
scenario for handling sewage and wastewater. This site is remote and is contained on an approved COGCC well pad. This temporary employee facility will provide housing for the Applicant's
employees, contractors, and subcontractors that are conducting drilling and completion operations on a nearby Well Pad 15-01. The Minor Temporary Employee Housing facility will be in
use year round to accommodate those considered to be "essential personnel" to the drilling operations. The installed facility is required to meet all applicable building and fire code
requirements. Estimated Dates of Operation: Installation: Removal: Total Estimated Time on Site: December 1, 2010 November 30, 2011 365 Days or less 0375 County Road 352, Building #2060.
Rifle, CO 81650 (970) 625·5900· Fax: (970) 625·5939 108 Eighth Street, Suite 401 • Glenwood Springs, CO 81601 (970) 945~8212' Fax: (970) 384·3470
o 697·1s.t)1 Pad G 697.1tMBPad .10'. ..". '.-,,' County Roads --Exisllng PriY<1ie Roads ~"~:==::JI ........... _ Miles o 0.5 2 O)(Y967·16-18 TEMPORARY HOUSING LOCATION OXYUSAWfPlP GARFIElD
COUNTY. COLOf:t6PO 2 ()\OLSSON ASSOCIATES N i
21691010<Xl20 6S97W d I ApproxImale .Dlstance To J Property Una Is 980' N o 697·16·IGPad C'I Milas ! 216'921400026 (Atea: iO,303I1CfGS) 0 0.125 0.25 0.5 ~m ~~ ~ OXY 007~1a-.16 O\OlSSON
DISTANCE TO PROPERTY LINE t2$i1-~f'G',O -0' N ~-~ Ox( USA WTP: LP 9> ..... GARFlEl[}COUNlY. COLORADO Tan~ 2 ~ -" A$SOe,;IATt'~ '>I'!m..~1t'" 3
~' ",.~~ r,.o.s-PU'Ul>C co "'~!UI l.K .. IMrAllIlUR ,---~ .'~ . PROPOSW DRfU,.aAIlP u.tolJ3POSmoN" $!l'JJ·4Q./i-NOIfTH 108'1768.1" WEST l.' i-• • 100 taMe 1""W .: _ k:.~\~,;~,.~, Toes.
R-9rw., PROPOSED DRILL OLlCP Site Plan -Well Pad 697-16-16D Housing Facilities: The Applicant has represented that a six-plex structure for temporary employee housing is to be located
on-site. A more detailed breakdown includes: Trailer Use Size Occupants 6 -Plex 1 Living 13'x58' Upto 24 6 -Plex2 ._.--Living 13' x 58' 6 -Plex 3 LivjnQ 13' x 58' 6 -Plex4 Living 13'
x 58' --~Plex5 Living 13' x 58' 6 -Plex 6 Living 13' x 58' Total Living on Location 24 or less -4
Buildings provided at 697-16-16D are constructed to meet all Garfield County building requirements. Certifications from the Colorado Department of Housing (CDOH) have been obtained demonstrating
that the buildings meet the appropriate specifications. The six-plex structure will be improved with the required sprinkler system as required for all units not placed a minimum of 20'
apart. Photographs of the Colorado Division of Housing certification tags have been provided. Should different CDOH approved units be placed on-site, written documentation will be provided
to the inspector during the Garfield County Building Department inspection. All trailers, potable water systems and wastewater systems will be located within the confines of the well
pad as approved by the COGCC. Water: The Applicant is proposing potable water including bottled water and potable water stored in potable water tanks. The potable water is to be hauled
to the facility using a water hauling contractor. The Applicant is required to use CDPHE certified potable water haulers who are obtaining the water from an approved source. All water
must be treated prior to delivery to a facility. The Applicant has represented that the facility is capable of storing 12,000 gallons of potable water with a 6-7 day capacity. The Applicant
has represented that the tanks will be refilled at a 2-3 day frequency. A 2,500 gallon . water tank for wildland fire suppression and a 1,600 gallon storage tank for internal fire suppression
in the six-plex structure are also proposed. The Applicant has provided a letter from Down Valley Septic, LLC stating that they will provide potable water hauling services for Oxy USA
WTP LP. Sewage: Sewage and Wastewater are proposed to be handled by a vault-and-haul system with an 8,000 gallon storage capacity. Dump stations will collect wastewater from each trailer
and transfers the wastewater to storage tanks. Tanks and lines will be insulated and heat traced to prevent freezing. Based on the Garfield County Unified Land Use Resolution 2008, the
Applicant will provide a minimum of 75 gallons per person per day of storage capacity for sewage and wastewater. As a result, the two (2) 4,000 gallon tanks are anticipated to provide
a 4-5 day capacity. The Applicant has represented that the tanks will be emptied every 2-3 days. In addition, the tanks are to be equipped with a secondary containment in case of leaks
occur and a high level alarm which will sound when the tank reaches 70% capacity. The Applicant has provided a letter indicating that Down Valley Septic, LLC. will provide the sewage
hauling service for Oxy USA WTP LP. Collected sewage will be disposed of at the Silt Wastewater Treatment Facility. Refuse: This facility is to be equipped with a minimum of the equivalent
of one thirty (30) gallon bear-proof refuse receptacle per trailer. . The receptacles will be emptied by a refuse hauler at least once per week and disposed of at the Garfield County
landfill. The Applicant has provided a letter from Down Valley Septic, LLC. stating they will be providing hauling service. Trash trailer equipment will be provided by Outpost Office.
Collected waste will be disposed of at a state certified location at the West Garfield County landfill. 5
Renewal: Minor Temporary Employee Housing Facilities are limited to a cumulative of one year on location. No renewals are available for Minor Temporary Employee Housing Facilities. Reclamation
and Revegetation: All housing structures and associated equipment will be located on the COGCC approved well pad. As such, reclamation is to be handled by the COGCC and secured through
the appropriate bond. Public Notice: The proposed location for the subject Minor Temporary Employee Housing facility is within the Resource Land District, Plateau sub-district. The Applicant
is the only surface owner within 200 feet of the Permitted Site and therefore public notice is not required. Referral Agencies: The Applicant has conducted all necessary referrals prior
to submittal of the application. The Garfield County Sheriff's Office and the De8eque Fire Protection District have signed the relevant forms as required. Previous Violations by Operator:
The Operator, Oxy USA WTP LP, is not currently under review or under any other code enforcement action by Garfield County in relation to a Minor Temporary Employee Housing Facility.
It is the Director's opinion that this Minor Temporary Employee Housing permit meets the requirements set forth in Section 7-808 (D) (2) "Minor Temporary Employee Housing Facilities
(Minor Permit)" of the Garfield County Unified Land Use Resolution 2008 as amended as long as the conditions listed below are satisfied. Section 7-808 (0) (2): The applicant shall adhere
to the following Minor Temporary Employee Housing Facility Characteristics and Standards: a. Minor Temporary Employee Housing Facilities, in the nature of Factory Built Nonresidential
Structures [as defined under C.R.S. 24-32-3302(a)] and/or recreational vehicles [as defined under C.R.S. 42-1-102 (61), with the addition that such truck, truck tractor, motor home or
camper trailer is being used for temporary living quarters and not recreational purposes], may be granted land use approval for projects related to commercial, industrial and mineral
extraction operations by the Building and Planning Department Director (Director), through the Minor Permit process. Such housing shall be of a temporary nature, and at the expiration
or other termination of the Minor Permit, all structures, foundations and associated infrastructure shall be completely removed. Such facilities are subject to all applicable requirements
of Garfield County building and fire codes (building code, fire code); state and federal permits and relevant fire protection district(s) fire code requirements. Minor Permits shall
have all of the following basic characteristics: 1) the Minor Temporary Employee Housing Facility and any associated infrastructure ("Minor Facility(ies)"} must be completely contained
within a state or federally permitted parcel (i.e. Colorado Oil and Gas Conservation Commission (COGCC) approved oil/gas well pad) in which reclamation and revegetation are secured with
the permitting agency (Permitted Site); and, 6
2) The Minor Facility is located at a Permitted Site for less than a cumulative of one (1) year; and, . 3) The Minor Facility shall have occupancy of nine (9) to twenty-four (24) people
who are employees, contractors or sUb-contractors of the operator and are safety of the related commercial, industrial, extraction or highway operations, Temporary employee housing facilities
that do not have the three characteristics listed above, i.e" have an occupancy of eight (8) or fewer people or 25 or more people, on location for more than a cumulative of one (1) year
or not completely contained within a Permitted Site, i.e, "Small Facility" or "Major Facility", are subject to the Major Impact Review process and standards and requirements contained
in Article 7-808(0)(1-3) and the enforcement provisions of Article XII. b. The Minor Facility shall adhere to the following Minor Permit standards: 1) Minor Facilities must comply with
all applicable federal, state and local laws and regulations, 2) Operator must keep and maintain appropriate records, to be provided to the County or any interested third party upon
request, to demonstrate that potable water supplied and sewage and wastewater meet the representations contained within the application, as required, 3) In no case shall unsafe water
be used for drinking nor shall raw sewage or contaminated water be discharged on the ground surface, The operator shall conduct monthly tests (or quarterly if an on-site disinfection
system is installed) and maintain records of potable water samples specific for coli form bacteria, Any tests indicating coli form contamination must be disclosed to the Garfield County
Board of Health or designee within 72 hours from the time the contaminated water was tested, 4) Minor Facilities shall be maintained in a clean, safe and sanitary condition, free of
weeds and refuse, Any hazardous or noxious materials that must be stored at the Minor Facility for operational or security reasons must be managed in accordance with all applicable federal,
state and local laws and regulations, 5) At least one thirty (30) gallon (4 cubic feet) wildlife-proof refuse container shall be provided for each factory built nonresidential structure
or recreational vehicle unit Said container(s) must be durable, washable, non-absorbent metal or plastic with tight-fitting lids, 6) Refuse shall be disposed of weekly, at a minimum,
Operators must keep appropriate records, to be provided to the County or any interested third party upon request, to demonstrate that refuse is collected in a timely fashion and disposed
of at a licensed facility, 7) Outdoor food storage is prohibited unless facilities that prevent the attraction of animals to the Minor Facility are provided, 7
8) Factory built nonresidential structures or recreational vehicle units equipped by the manufacturer with a fire sprinkler system, fire detection system, and/or alarm system shall be
inspected, tested, and maintained in accordance with 2003 IFC §901.4 and §901.6 or subsequent adopted fire code and as required by the relevant fire protection district(s). Smoke alarms
and manual. fire alarm systems shall be installed, inspected and maintained in all other Jactory built nonresidential structures or recreational vehicle units in accordance with 2003
International Fire Code (lFC) §907.2.9 and §907.2.10 or subsequent adopted fire code and the reqUirements of the relevant fire protection districts . . 9) Single-station carbon monoxide
alarms shall be placed in each factory built nonresidential structure or recreational vehicle unit. 10) One (1) or more approved fire extinguisher(s) of a type suitable for flammable
liquids, combustible materials and electrical fires (Class A, Class B and Glass G), or dry chemical, shall be located in each factory built nonresidential structure or recreational vehicle
unit and placed in accordance with applicable codes. 11) Inhabitants of the Minor Facility shall be Temporary Employee Housing Operator's employees and/or subcontractors, working on
the related commercial, industrial or mineral extraction operation, and not dependents of employees, guests or other family members. 12) Within 10 days following the expiration or other
termination of the Minor Permit or represented date of removal identified within the Minor Permit, all housing structures, foundations and associated infrastructure shall be completely
removed. The Operator shall provide the Department with photos, dated and signed by the Operator's Compliance Officer, indicating that all housing structures, foundations and associated
infrastructure has been removed within the specified timeframe. 13) No domestic animals are allowed at a Minor Facility. 14) A water storage tank shall be required to provide water to
the sprinkler system and initial suppression activities. The size of the water tank shall be determined based on sprinkler calculations and initial suppression demands. The size of the
water storage tank shall be determined by the relevant fire protection district. If the Minor Facility is located outside the boundaries of a fire protection district, than each Minor
Facility shall have at least one (1) water storage tank with a minimum of 2,500 gallons of water for initial fire suppression, operation of sprinkler systems (if applicable) and wild
land fire protection. 15) All emergency situations requiring action by any government agency or fire protection district shall be documented in writing and presented to the Planning
Department and Garfield Gounty Sheriff's Office within 24 hours of the occurrence. 16) All required Access Permits shall be obtained from the Garfield Gounty Road and Bridge Department
or the Colorado Department of Transportation. 8
.17) The Garfield County Sheriffs Office and relevant fire protection district(s) must be . notified at least 24 hours prior to installation and removal of each Minor Facility. The Department
shall be copied on all such notification, whether hard copy or electronic. . 18) The Operator shall maintain records identifying workers, whether employees or sub-contractors, and documenting
the dates that each worker is housed at the Minor Facility. Such records shall be provided to the County or any additional third party upon request. 19) Wastewater Disposal: (a) Vault
System: All vault systems shall be designed and installed to accommodate the maximum number of persons, identified within the Minor Permit application, who will inhabit the Minor Facility.
In addition, all vault systems shall be equipped with an overflow alarm device. Vault systems shall be designed to accommodate a minimum of 75 gallons of wastewater per person per day.
If a vault system is proposed or has been approved, the Temporary Employee Housing Operator/Operator must: (1) Demonstrate that year-round vehicular access is available and maintained
for safe and regular access for sewage hauling vehicles. (2) Provide a copy of the contract for hauling sewage. (3) Maintain all sewage disposal records including but not limited to
trip logs/reports and landfill receipts as public records, available to the County and/or any other interested third party upon request. (4) If the total waste production from a facility
will be 2,000 gallons per day or greater based on a production of 75 gallons of wastewater generation per person per day, then the facility shall be serviced by an ISDS installed as
per State standards. HaUled sewage and wastewater service shall not be permitted for any facility which will generate a total of 2,000 gallons or greater of wastewater and sewage per
day. (b) Individual Sewage Disposal System (lSDS): If an ISDS is proposed or has been approved, then it shall be designed, installed and operated to accommodate the maximum number of
persons who will inhabit the Minor Facility and shall otherwise be operated in accordance with the Garfield County ISDS regulations as contained in Resolution 2008-82. Should you have
additional questions, do not hesitate to contact this office. Sincerely, !l/l~f(f CtUi/-U~· ~ Molly OrkildLLarson, AICP, RLA Senior Planner 970.625.5903 9
, 1111 wt:Ptit. 51///Cd>-:!'/o/~.tIt h't" ;;?"tJ~ £'&C-/f,41 C " f/C/J:/"¥'c. ~ ~,FC. .f~:I://,1/, P'/'/-'H4'HK~/t'~ ~/4C~;?~5. "e;;J/d~;, ~ tk:> , L.t,k4~ If7U/L4Hd-lLf ~ ,Per.de .5't'el..
/ppe ,. t;"J/-t/~#lj.;lrtM~ ,;::;t9c) a4"k,; /z-• hH,f'/4"'ec~/t'"../~~,.//!o/VII'eII' ,.,(; Co, /)ij/t!a4nr . .. ;4J(/1 ",c;~ .P/~.Jr/;;I-r/jbX/"/kk".t:; ¥,¥I#)k/>j"$hh ~~~d ;:;-Co
. .-'# ¥t'c~hf . APPROVED SUBJECT 1'0 NOTED EXCEPTIONS & INSPEcnONS GARFIELD COUNTY Bun;:; DEP-AJENT .o.t~ r~ By LDCOPY NO INSPECTION WITHOUT THESE PLANS ON SITE page of 0 ..... MM .<..C...<...c.
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OXY USA WTP LP, Well Pad 697-16-16 Temporary Employee Housing Housing Details The following table details the trailers and estimated number of occupants for temporary employee housing
at the 697-16-16 well pad. Trailer Use Size Occupants 6 -Plex 1 Living 13' x 58' Up to 24 6 -Plex 2 Living 13' x 58' 1 6-Plex 3 Living 13' x 58' 6 -Plex4 Living 13' x 58' 6 -Plex 5 Living
13' x 58' 6 -Plex 6 Living 13' x 58' Total Living on 24 or less Location Buildings provided at 697-16-16 are constructed to meet all Garfield County building requirements. Certifications
from the Colorado Department of Housing (CDOH) have been obtained demonstrating that the buildings meet the appropriate specifications. The six-plex structure will be improved with a
sprinkler system as required for all units not placed a minimum of 20' apart. Photographs of the Colorado Division of Housing certification tags have been provided. Should different
CDOH approved units be placed on-site, written documentation will be provided to the inspector during the Garfield County Building Department inspection. All trailers, potable water
systems and wastewater systems will be located within the confines of the well pad as approved by the COGCC. Oxy Minor Permit Application for Temporary Housing 697-16-16
ATCO STRUCTURES DIBOLL, TX SUBJECT: Ground Anchor Tiedown Design ENGR: KEVIN M. FINN, P.E. 2700 W. WILDEN AVE., STE 4 GOSHEN, IN 46528 THE LOAD CONDITIONS FOR THE FOOTING DESIGN AND
TIEDOWN SYSTEM ARE BASED ON A VARIOUS WIND SPEEDS THE BUILDING CODE REFERENCE IS 2003 INTERNATIONAL BUILDING CODE THIS CALCULATION IS FOR DEVELOPMENT OF THE GROUND ANCHORING TIE DOWN
SYSTEM FOR A MANUFACTURED MODULAR STRUCTURE. THE ASSUMED MAXIMUM UNIT WIDTH IS 11' 9" WIDE WIND LOAD IS BASED ON THE CONDITION OF A MAX. 15' BUILDING HT OFF THE GROUND HORIZONTAL WIND
LOAD SEE BELOW FOR ACTUAL FLAT PITCHED ROOF 11 75 FT DEAD LOAD " 44 PSF EFFECTIVE ROOF WIND LOAD VS .. ---+ WIND SPEED AND WALL PROJECTION 10.5 FT • /. I "j AS IS--;;;?oNNECTION BETWEEN
UNITS FI n 92.0 IN DESIGN OF TIEDOWN STRAPS & WALUROOF/FLOOR PROJECTION -WIND SPEED MAX. DESIGN TENSION LOAD OF STRAP 1 ANCHOR 3150 LBS HORIZONTAL COMPONENT BASED ON ANGLE OF STRAP =
2227.05 LBS MAXIMUM SPACING OF STRAP TIEDOWN -HORIZONTAL WIND LOAD (LEEWARD) LATERAL LOAD APPLIED TO FLOOR RIM FRICTIONAL RESISTANCE SPACING OF GROUND ANCHORS 90 MPH, EXP. C 6.189615
PSF 64.99 PLF 124.08 PLF NON RE FT O.C. FRICTIONAL RESISTANCEADEOUATE FOR HORIZONTAL RESISTANCE BASED ON 0.2 FRICTION FACTOR STRAP -ANCHOR SPECIFICATIONS -RATED AT MIN. 3150 LBS ANCHOR
-ANCHOR-SUR DIVISION MODEL 4BSH OR MINUTE MAN ANCHORS MODEL 650-DH STRAP -FEDERAL SPECIFICATION 00-S-781 H, TYPE 1, CLASS B, GRADE 1 -1-1/4" x 0.035" VERTICAL TlEDOWN -90 MPH, EXP. C
WIND UPLIFT " 10.30473 PSF OVERTURNING WIND UPLIFT REACTION (after subtracting dl) "" -111.88 PlF-NOSTIRAPREO. REACTION AT SIDEWALL = (WIND PRESS. x WALL HP2/2 -2/3 (DEAD LOAD) x UNIT
WIDTH'2/2) 1 UNIT WIDTH -173.53 LBS PER LINEAL FT. OF LENGTH OF BUILDING OKAY NO STRAP REO. FOR OVER TURNING "-. , ... " ~
ATCO STRUCTURES DIBOLL, TX SUBJECT: Ground Anchor Tiedown Design ENGR: KEVIN M. FINN. P.E. 2700 W. WILDEN AVE., STE 4 GOSHEN, IN 46528 THE LOAD CONDITIONS FOR THE FOOTING DESIGN AND
TIEDOWN SYSTEM ARE BASED ON A VARIOUS WIND SPEEDS THE BUILDING CODE REFERENCE IS 2003 INTERNATIONAL BUILDING CODE. THIS CALCULATION IS FOR DEVELOPMENT OF THE GROUND ANCHORING TIE DOWN
SYSTEM FOR A MANUFACTURED MODULAR STRUCTURE. THE ASSUMED MAXIMUM UNIT WIDTH IS 11' 9"WIDE SIX UNITS STACKED SIDE BY SIDE HORIZONTAL WIND LOAD SEE BELOW FOR ACTUAL WIND LOAD VS.---+ WIND
SPEED WIND LOAD IS BASED ON THE CONDITION OF A MAX. 15'BUILDING HT. OFF THE GROUND FLAT PITCHED ROOF 1175 FTIPERI '/0 DEAD LOAD = 44 PSF EFFECTIVE ROOF AND WALL PROJECTION 10.5 FT 92.0
IN DESIGN OF TIEDOWN STRAPS & WALUROOFIFLOOR PROJECTION -WIND SPEED MAX. DESIGN TENSION LOAD OF STRAP I ANCHOR 3150 LBS HORIZONTAL COMPONENT BASED ON ANGLE OF STRAP = 2227.05 LBS MAXIMUM
SPACING OF STRAP TIEDOWN -HORIZONTAL WIND LOAD LATERAL LOAD APPLI ED TO FLOOR RI M FRICTIONAL RESISTANCE SPACING OF GROUND ANCHORS 90 MPH, EXP. C 16.093 PSF 168.98 PLF 186.12 PLF NONE
REQ. FRICTIONAL RESISTANCE ADEQUATE FOR HORIZONTAL RESISTANCE BASED ON 0.2 FRICTION FACTOR VERTICAL TlEOOWN-90 MPH, EXP. C WIND UPLIFT ::;:: 10.30473 PSF WIND UPLIFT REACTION (after
subtracting d!) = -111.88 PLF -NO STRAP REO. OVERTURNING REACTION AT SIDEWALL = (WIND PRESS. x WALL HT.A2 12 -2/3 (DEAD LOAD) x UNITWIDTH'2/2) I UNIT WIDTH -117.30 LBS PER LINEAL FT.
OF LENGTH OF BUILDING OKAY NO ~ ...
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DANOER'EUSr:. p e u T C AuseR I . OcoES-. ..O , .L... ,I. :..S..S...U...R....E...S. .-O.A.. "A ..V...E.. S oU LA MORT. woo , ........ I> .. ,~ ..... _ . .. , ~ 0 ' • • _ •• -... .. .
. .. . ~ ......". . ,...Jc P~ LIOAO$O . CAU -g -.... ,.. -e: RICO:';" :; ;~::!!~~~1t~~:.~~.:.:~~.~.~R·~..,~-: ..~ ·:;:.~:~'!'. .. ·:.:.':·..:'·
•
PROPOSED ORllLCAMP NAD 83 POSIT/ON: 39" 31' 40.6" NORTH 100'12'50.1" WEST o 100 -H SCAlE; ' .... 100' T.6S. R.97W. SECTIONtS SEcnON16 PROPOSED DRILL CAMP DllIYlNG DIREC/'IONS FROM THE
TOW Of DEBfDUf: BEGINNING AT THE INTERSECTION OF ROAN CREEK ROAD (MESA COUNTY ROAD 45) AND INTERSTATE HIGHWAY NO. 70 AT E)(IT NO. 62 SOUTH OF THE TOWN OF DE8EQUE. MESA COUNTY, COLORADO;
TRAvtL NORTHERLY ON ROAN CREEK ROAD (MESA COUNTY ROAD 45) fOR 4.0 MILES TO THE MESA-GARfiELD COUNTY LINE. CONTINUE ON ROAN CREEK ROAD (GARFIELD COUNTY ROAD 204) FOR 4.35 MILES TO CONN
CREEK ROAD (GARFIELD COUNTY ROAD 213). TURN RIGHT AND TRAvtL EASTERLY AND NORTHERLY FOR 3.9 MILES TO THE O)(Y ROAD ENTRANCE AND GUARD SHACK. END JRAWI aN PUBliC ROADS AND AfGIN TRAVEl
ON pRIVATE ROADS THEN CONTINUE NORTHERLY AND NORTHEASTERLY B.65 MILES ON on ROADS To A "T" INTERSECTION \\11TH AN EAST-WEST ROAD. THEN TURN RIGHT AND TRAvtL EASTERLY AND TRAvtL 0.55
MILES TO A "Y" INTERSECTION. THEN BEAR LEfT AND TRAVEL 1.22 MILES TO THE DXY. CASCADE CREEK 697-15-01 PAD. THEN TURN AND TRAVEL SOUTHWESTERLY 0.25 MILES TO THE LOCATION. SURVEYOR'S STATEMENT
I, RONALD C. RENNKE, AN EMPLOYEE AND AGENT FOR D. R. GRiffiN &: ASSOCIATES, INC. STATE THE SlIT PLAN SHoiIN HEREON IS A CORRECT REPRESENTATION OF THE RESULTS OF A SURVEY MAOE BY ME OR
UNDER MY AUTHORITY ON APRIL 5, 2010 FOR THE PROPOSED CASCADE CREEK 697-16-16 DRILL CAMP. FROM THE TOWN OF PARACHUTE-8EGINNING AT THE INTERSECTION OF GARFIELD COUNTY ROAD 315 AND INTERSTATE
HIGHWAY NO. 70 ON THE EAST SIDE Of PARACHUTE, GARfiELD COUNn, COLORADO; TRAvtL NORTHWESTERLY ON GARFIELD COUNTY ROAD 315 FOR 7.3 MiLES TO THE GAROEN CUL TCH RQAD TURNOfF. END TRAWl ON
PllA! IC ROAOS AND BEGIN TRAW! ON PRIVAIf ROADS TURN LEFT AND TRAVEL NORTHERLY AND WESTERLY FOR 0.65 MILE TO THE LOWER \\I1LLlAMS GUARD SHACK. THEN CONTlNUE WESTERLY 5.6 MILES TO THE
UPPER WILLIAMS GUARD SHACK AND A "Y' INTERSECTION. BEAR LEFT ON AN ARTERIAL WELL SERVICE ROAD FOR 2.1 MILES TO A or' INTERSECTION. CONTINUE STRAIGHT (BEARING RIGHT AT THE "T") FOR 2.B5
MILES TO A "y. INTERSECTION. BEAR RIGHT AND TRAVEL 1.22 MILES TO THE O)(Y, CASCADE CREEK 697-~-01 PAD. THEN TURN AND TRAVEL SOUTHWESTERLY 0.25 MILES TO THE LOCATION. rU ·"ri 1 :>,1 Hrl
rtl aJ <1 ,. o aJ ·ri rl .ow a,J. ·ri rtl <000 1 1 SURFACE OWNERSHIP OXY USA WTP LP 760 HORIZON DRI",[, SUITE 101 GRANO JUNCTIOI;, COLORADO 81506 (970) 263-3637 INSTALLATION AND REMOVAL
DATES 1. INSTALLATION OATE: DECEMBER 1, 2010 2 REMOVAL DATE: NOVEMBER 30. 2011 3. CUMULA nVE TIME: 365 DAYS PRIVATE ROAD PUBLIC ROAD ROUTE TO SITE PRIVATE ROAD ROUTE TO SITE OXY PROPERTY
aOUNDARY YlCINITY MAP SCALE: 1"",,5000' 24 HOUR RESPONSE CONTACT INFORMA.TION: 1. ALONZO HERNANDEZ (HES SUPERINTENDENT), OXY USA WW LP (970) 263-3809 (970) 980-5055 2. BREn KENNEDY,
(Sr. HES SPECIALIST), OXY USA I'll? LP (970) 253-3601 (970) 201-2305 3. ST. MARy'S HOSPITAL, GRANO JUNCTION, CO. (970) 244-7050 4. ST. MARY'S CAREFLIGHT HELICOPTER, GRANO JUNCTlON. CO.
(970) 332-492.3 5. GARFIELD COUNTY SHERRIFF'S OFfiCE, RIFLE. CO. (970) 625-8095 6. OE8EQUE FIRE PROTECTION DISTRICT P.O. 80X 180. OE8EOUE, CO. 81630 ono) 283-8632 7. DEBEGUE VOLUNTEER
RESCUE DEPARTMENT, DEBEOUE, CO. (970) 283-5907
""'--"_':: :~. !;otos ',::".,..,. --~-~ _rAU_o.ou.CN WAn",ANII'I'lM' ~-~ ._-PROPOSED DRIUt;,4MP HAD U 1'OS/1'ION: ,,, :f, fD.' " NORrH fOll·,,'56.'" W£6r T.6 S. R. t/rw. BEcrlONtS SECTION'S
PROPOSED DRILL ctMP DRIVING DIRECTIONS rROM lHf roW Of REArOUE' BEGINNING AT THE INTERSECTION Of ROAN CREEK ROAD ( ~ESA COUNTY ROAD 45) AND INTERSTATE HIGHWAY NO. 70 AT EXIT NO. 62 SOUTH
OF 11-1£ TOWN Of D£B£QUE, MESA COUNTY, COLORADO: TRAVEL NORTHERLY ON ROAN CR£EK ROAD (MESA CouttTY ROAD 45) FOR 4.0 MILES TO THE UESA-GARflELD COUNTY UNE. CONTINUE ON ROAN CREEK ROAC
(CARFIELD COUNTY ROAC 204) FOR 4.35 MILES TO CONN CREEK ROAD (GARfiELD COUNTY ROAD 213). ruRN BIGHT AND TRAVEL EASTERLY AND NORTHERLY rOR 3.9 MILES TO Tl1[ OXY ROAD ENTRANCE ANO GUARD
SHACK END TRA\.fl ON PUR! IC ROAPS ANp BEGIN %''xfl pN pRIYATf ROAps THEN CONTINUE NORTHERLY AND NORTl1[ASTtRL Y B.65 MILES ON OXY ROADS TO A ", INTERSECTION W1Tl1 AN EAST-WEST ROAD.
THEN TURN RIGHT AND TRAVEL EASTERLY AND TRAVEL 0.55 MILES TO A "Y-INTERSECTION. TIiEN BEAR lEFT ANO TRAVEL 1.22 I.IlLES TO THE OXY, CASCADE CREEK 697-15-01 PAD. THEN TURN AND TRAVEL
SOUTHWEST£RLY 0.2! WILES TO THE LOCAnON. SURVEYOR'S STATEMENT I. RONAlD C. RENNKE. AN EMPLOYEE AND ACENT FOR O. B. GRIFFIN "'ASSOCIATES. INC. STATE THE SITE PLAN SHO'MII HER(ON IS A
CORRECT REPRESENTATION OF THE RESULTS OF A SURVEY WADE BY ME OR UNDER MY AUTHORITY ON APRIL 5. 2010 FOR TH£ PROPOSEO CASCADE CRE£)( 697-16-16 DRILL CAMP. fROM THE TOW Of PABACHl!Tf'
BECINNING AT THE INIDSECTION Of GAAflELD COUNTY ROAD 315 AND INTERSTATE HIGHWAY NO. 70 ON THE EAST SIDE Of PARACHUTE, GARflELD COUNTY. COLORADO; TRAVEL NORTllI'IESTERl Y ON GARfiELD
COUNTY ROAD 315 fOR 7.3 t.IlLES TO THE CARDEN GUl TCH ROAD ruRNOfF. rHg mAW ON P'!!!!C ROAns ANg emN TRA'xf! ON pRI'MTf ROAgs ruRN LEfT AND TRAVEL NORTl1ERL Y ANO Ylt:ST[Rl Y FOR 0.65
MILE TO THE LOYlt:R WlLUAMS GUARD SHACK. THEN CONTINUE WESTERLY 5.6 MILES TO THE UPPER WILLIAMS GUARD SHACK ANO A " '(' INTERSECTION. BEAR LEfT ON AN ARTERIAL WELL SERVICE ROAD FOR 2.1
MILES TO A ", INT[RSECTION. CONTINUE STR.-\IGHT (BEARING RietH AT THE "I) FOB HIS MILES TO A ' yINTERSECTION. BEAR RIGHT AND TRAVEL 1.22 I.IlLES TO THE OXY, CASCADE CREE.!( 697-~-01
PAD. THEN ruRH AND TRAVEl SOUTHWESTERlY 0.25 MIlES TO mE: LOCATION. rei -.".'. I Q~ ro Q) o<1 > Q) -... ri "-,Q) U> -... ro 'OOl I I SURFACE OWNERSHIP OXY USA WTP LP 760 HORIZON DRIVE.
SUITE 101 GIlANO JUNCTION. COlORADO 81506 (970) 26.3-36.37 2. REMOVAL DATE: NOVEMBER 30. 2011 .3. CUMULAnVE TIME: 365 DAYS V1CINTI'Y MAP SCALE: 1"_ 5000' PRIVATE ROAD PUBUC ROAD ROUtt
TO SITE PRIVATE ROAD ROUTE TO SITE OXY PROP£RTY BOUNOARY :u HOUR RESPONSE CONTACT INFORMATION: ~ ~ ~ ~ ~ ~ ~ ~ .; ~ <:i ~C '~" ~-~s es~ ~C ~::1~'<!~ ~~~o ;~" ~ :g=~6c ~<.i"i!o<lt.;>
c~ ~;! ~ u ~ ~ ~ ~ ~ l! '" ~ siO: ~ ili ti ~ Q , ~ .. <:> ~ ~ ~ ",-~ ~ :$ ~ ~ U 0 Cl «~ ~ Oil ~~ ~ .... il: i!!~'" ~ :5 ~ CI) fIi' '? ....:~ cd~ C1}~tI) :.::Q::~ u::3i~ ..lc:~ "~Q" ~o:
I. ALONZO HERHANO£Z (HES S1.lPfRlNTENOENT). OXY USA WTP LP (970) 263--3609 5. CARflELD COUNTY SHERRIff'S OFnC£. RIFlE, co. (970) 625-8095 (970) 981>-6055 2. BRETT KENNEDY. (Sr. HES SPECIAUST).
on USA WTP LP (970) 263-3601 (970) 201-2305 J. ST. MARYS HOSPITAL. CRANO .... JNCnON. CO. (970) 244-7050 4. ST. MARy'S CAREFUGHT HEUCDPTER. CRAND ..uNCTION. co. (970) 332-4923 6. OEBEOUE
FIRE PROTECTION OISTRICT P.O. BOX 1110. D[BEooE. CO. 816.lO (970) 211.J-86.32 7. OESEGUE VOlUNTEER RESCUE DEPARTMENT, DEBEOIJE. CO. (970) 283-5907
Io'ILLIAMS HIGH fPRESSURE LINE 4' UNDERGROUND GAS PIPELINE 2' .... ATER LINE INSTALL BEAR PROOF TRASH CONTAINER INSTALL 2500 GALLON ___ WA TER TANK FOR _______ WILDLAND FIRE SUPPRESSION
INSTALL POTABLE /WATER TANK PROPOSEO ORILL CAMP NAO 83 POSITION: 39° 3" 40.6" NORTH '08° '2' 58. ' " WEST INSTALL 6 UNIT DRILL CAMP INSTALL SEPTIC SKIDS INSTALL GENERATOR "-"-o 100 ""'I-~
"I I SCALE: 1"=100' , ~~ l I , , .J) . ( r \ \ \ ---------~------------------' ------T. 65. R. 91W 5ECTlON15 SECTION '6 ---""-\ I \ \ \ //( \ \ \ \ I I I I ! ! \ \ I PROPOSED DRILL CAMP
DRIVING DIRECTIONS FROM THE TOWN OF DEBEOUE: BEGINNING AT THE INTERSECTION OF ROAN CREEK ROAD (MESA COUNTY ROAD 45) AND INTERSTATE HIGHWAY NO. 70 AT EXIT NO. 62 SOUTH OF THE TOWN OF
OEBEOUE, MESA COUNTY, COLORADO, TRAVEL NORTHERLY ON ROAN CREEK ROAD (MESA COUNTY ROAD 45) FOR 4.0 MILES TO THE MESA-GARFIELD COUNTY LINE. CONTINUE ON ROAN CREEK ROAD (GARFIELD COUNTY
ROAD 204) FOR 4.35 MILES TO CONN CREEK ROAD (GARFIELD COUNTY ROAD 213). TURN RIGHT AND TRAVEL EASTERLY AND NORTHERLY FOR 3.9 MILES TO THE OXY ROAD ENTRANCE AND GUARD SHACK. END TRAVEL
ON PUBLIC ROADS AND BEGIN TRAVEL ON PRIVATE ROADS. THEN CONTINUE NORTHERLY AND NORTHEASTERLY 8.65 MILES ON OXY ROADS TO A ''T'' INTERSECTION WITH AN EAST-WEST ROAD. THEN TURN RIGHT AND
TRAVEL EASTERLY AND TRAVEL 0.55 MILES TO A ''y'' INTERSECTION. THEN BEAR LEFT AND TRAVEL 1.22 MILES TO THE OXY, CASCADE CREEK 697-15-01 PAD. THEN TURN AND TRAVEL SOUTHWESTERLY 0.25 MILES
TO THE LOCATION. SURVEYOR'S STATEMENT I, RONALD C. RENNKE, AN EMPLOYEE AND AGENT FOR D. R. GRIFFIN & ASSOCIATES, INC. STATE THE SITE PLAN SHOWN HEREON IS A CORRECT REPRESENTATION OF
THE RESULTS OF A SURVEY MADE BY ME OR UNDER MY AUTHORITY ON APRIL 5, 2010 FOR THE PROPOSED CASCADE CREEK 697-16-16 DRI LL CAMP. ~~ ...... I-Fit , ... ' -,N , '~ ~ . ) " -:"'ilT' ,'"
., . " ¥,-z.s:/;~ ,;} , /.... '. ' COLORA o . .17065 FROM THE TOWN OF PARACHUTE: BEGINNING AT THE INTERSECTION OF GARFIELD COUNTY ROAD 315 AND INTERSTATE HIGHWAY NO. 70 ON THE EAST SIDE
OF PARACHUTE, GARFIELD COUNTY, COLORADO, TRAVEL NORTHWESTERLY ON GARFIELD COUNTY ROAD 315 FOR 7.3 MILES TO THE GARDEN GUL TCH ROAD TURNOFF. END TRAVEL ON PUBLIC ROADS AND BEGIN TRAVEL
ON PRIVATE ROADS. TURN LEFT AND TRAVEL NORTHERLY AND WESTERLY FOR 0.65 MILE TO THE LOWER ~LLlAMS GUARD SHACK. THEN CONTINUE WESTERLY 5.6 MILES TO THE UPPER WILLIAMS GUARD SHACK AND A
"y" INTERSECTION. BEAR LEFT ON AN ARTERIAL WELL SER~CE ROAD FOR 2.1 MILES TO A "T" INTERSECTION. CONTINUE STRAIGHT (BEARING RIGHT AT THE "T") FOR 2.85 MILES TO A ''y'' INTERSECTION.
BEAR RIGHT AND TRAVEL 1.22 MILES TO THE OXY, CASCADE CREEK 697-15-01 PAD. THEN TURN AND TRAVEL SOUTHWESTERLY 0.25 MILES TO THE LOCATION. ,. { . < , , ' \ ,./, I ,' -~ , SURFACE OWNERSHIP
OXY USA WTP LP 760 HORIZON DRIVE, SUITE 101 GRAND JUNCTION, COLORADO 81506 (970) 263-3637 , ,, , -, , INSTALLATION AND REMOVAL DATES 1. INSTALLATION DATE: DECEMBER 1, 2010 2. REMOVAL
DATE: NOVEMBER 3D, 2011 3. CUMULATIVE TIME: 365 DAYS , -_ I J ';';:" " --, I , /" ,, -l! ! , ' ....-j . " \ f , -, , I .• , ' .•. ".. \0 ',' PUBLIC ROAD PRIVATE ROAD " . 1-;" . PARACHU,T
E.t. " , I, l' 'r , Ii ..,..-n'-, r~:~i ,f t I J' ,.,t . PUBLIC ROAD ROUTE TO SITE PRIVATE ROAD ROUTE TO SITE OXY PROPERTY BOUNDARY _.. _.. _.. _.. .. .. -VICINITY MAP SCALE: 1"~5000'
24 HOUR RESPONSE CONTACT INFORMATION: 1. ALONZO HERNANDEZ (HES SUPERINTENDENT), OXY USA WTP LP (970) 263-3609 (970) 980-6055 2. BRETT KENNEDY. (S,. HES SPECIALIST), OXY USA WTP LP (970)
263-3601 (970) 201-2305 3. ST. MARY'S HOSPITAL, GRANO JUNCTION, CO. (970) 244-7050 4. ST. MARY'S CAREFLIGHT HELICOPTER, GRAND JUNCTION, CO. (970) 332-4923 5. GARFIELD COUNTY SHERRIFF'S
OFFICE, RIFLE, CO. (970) 625-8095 6. DEBEOUE FIRE PROTECTION DISTRICT P.O. BOX 180, DEBEOUE, CO. 81630 (970) 283· 8632 7. DEBEGUE VOLUNTEER RESCUE DEPARTMENT, DEBEOUE, CO. (970) 283
-5907
Garfield County Building & Planning Department 108 8th Street Suite 401 Glenwood Springs, CO 81601-Phone: (970)945-8212 Fax: (970)384-3470 Project Address Parcel No. Subdivision 216921400026
DEBEQUE. CO Owner Information Address OXY USA WTP LP 760 Horizon DR Grand Junction CO 81506 PefmitNO.SEPT,.7-10-1631 Issue Date: 12/1/2010 Phone . P~I!l1't1"'PEi:SflPticf'e","it . <WoikCJa~sifiliatio
n:Ne.w Peunit.Status:.Active Expires: 12/01/2011 Section Township Range Cell Contractor(s ) Phone Primary Contractor Required Inspections: Proposed Construction I Details Vault and haul
associated with drill rig minor temporary employee housing at well pad 697-16-16 FEES DUE FEES PAID Valuation: $ 0.00 Total Sq Feet: o Fee Amount InvTolal Paytype Amt Paid Amt Due Septic
Fee -New Total: Wednesday, December 1,2010 $73.00 $73.00 Inv # SEPT-7-10-20348 $ 73.00 Credit Card $73.00 $ 0.00 Fo"n'p"lIon".II: 1 (888)868-5306 Inspection IVR See Permit Record Building
Department Copy 2
I 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8'h Street, Suite 40 I, Glenwood Springs, Co 8 I 60 I Phone: 970-945-8212 /Fax: 970-384-3470 /Inspection
Line: 970-384-5003 w\.\ w. 'arl-le Id-counl v.l;om Parcel No: (this informa6on is available al the assessors office 970-945-9134) 216921400026 Job Address: (if an address has not been
assigned, please provide Cr, Hwy or Street Name & City) or and legal description i\pp . 22 mi l es NW of Town of Parachute -NE 1/4 Sec 16 T6S R97W 6th well P.M. lol Size: lol No: Block
No: Subd.l Exemplion: 0,303 Acres N!A N!A N!A Owner: (fHoperty owner) Mailing Address 160 Horizon Dr Ste. '"I Ph: OXY USA WTP LP Gr;;md Jum:tlon, Co. 81 506 970 -2 63-3637 pad 697-16-16
All Ph: Contractor: Mailing Address 760 Ilodzon Drive Ste. 101 OXY USA WTP LP Grand Junction, CO AI S06 Ph: 970 -2 63-3637 All P'97 0 -412 -2 77 6 Engineer: N!A Mailing Address Ph: All
Ph: PERMIT REQUEST FOR: (X) New Installation ( ) Alteration ( ) Repair WASTE TYPE: ( )Dwelling ( )T ransient Use (X)Commercial or industrial ( )Non-Domestic wastes ( )Olher Describe
BUILDING OR SERVICE TYPE: Sei)!age ~alll ts associated i)!j tb c;t:;ill ~j g temgQ~~~ emD1Q~ee hOllsjng Pad 697 -16-16 Number of bedrooms N/A Garbage Grinder ( )Yes (X)No SOURCE & TYPE
OF WATER SUPPLY: ( )WEll ( )SPRING ( )STREAM OR CREEK (X)CISTERN If supplied by COMMUNITY WATER, give name of supplier: kla t eJ:: hauled to locatjcD by Down ~JJey Se~tjc DISTANCE TO
NEAREST COMMUNITY SEWER SYSTEM: Town of E:a;r;:agbyte a Qg 22 mjl~s tQ t he SQl.Itneast Was an effort made to connect to the Community System? NQ -Qistgn~e tQo great YOUR INDIVIDUAL
SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND CONDITIONS: Depth to 1st Ground Water Table ace 80 f eet Percent Ground Slope < lQ% TYPE OF INDIVIDUAL SEWAGE
DISPOSAL SYSTEM (IS OS) PROPOSED: ( )Seplic Tank ( )Aeralion Planl (XlVaull ( )Vaull Privy ( )Composling Toilel ( )Recycling, Polable Use ( jOlher. Describe ( )Recycling, olher use (
)Pil Privy ( )Incineration Toilet ( )Ghemical T oilel FINAL DISPOSAL BY: ( )Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiralion ( )Sand
liller ( )Waslewaler pond (X)Other-Describe TQ:dD Qf Ne:d Cas t le Wa st ~ ~tet T'e~ tm~nt Ea~ilit ~ Will effluent be discharged directly into waters of the state? ( )YES (){)NO PERCOLATION
TEST RESULT: (to be completed by Registered Proressional Engineer, if the Engineer does the Percolation Test) Minutes MLA per inch in hole No.1 Minutes NLA per inch in hole No.3 Minutes
N /A per inch in hole No.2 Minutes tUB. per inch in hole No._ Name, address & telephone of RPE who made soil absorption test: N/A Name, address & telephone of RPE responsible for design
of the system: N/A Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional test and reports as may be required by Ihe
local heallh departmenllo be made and lurnished by Ihe applicanl or by Ihe local heallh departmenl lor purposed 01 Ihe evalualion 01 Ihe applicalion; and Ihe 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 besl 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 undersland Ihal any lalsilicalion or misrep;*enlalion may resull in Ihe denial 01 Ihe applicalion or revocalion
01 any permit granled based upon said applicalion and leg~! ~cli~n~ perj~s 7~J~ ~. ~/6 /t) OWNERS SIGNATURE DATE /'PD 7~ .OO l\ccllo CL STAFF USE ONLY Permit 9 ~. 00' perkFN1A Total
fees: Building Pel'mit #: 13. 00 -\ (000 Septic Permit #: 3'EPT-i -IO -\lo~1 Issue D3,e& -0 I-(}O [0 Building & Planning Dept: ~~ /:0~/AP OVAL DATE