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. 1655 CR 109 239512302002
GLENWOOD SPRINGS, CO 81601-Owner Information Address 1655CR109 Permit NO. SEPT -3-11-1956 ,'.' 0/Permit .Type:Septic Permit Wolk Classification:. Repair -T-PermitSlalus: Active Issue
Date: 3/3112011 Expires: 03/30/2012 Subdivision Section Township Range LOUGH SUBDIVISION Phone Cell Brent Lough 948-2810 Glenwood Springs CO 81601 Contractor(s ) Phone Primary Contractor
Proposed Construction I Details Replace 1500 Gallon tank with 2000 gallon concrete Valuation: $ 0.00 FEES DUE Fee Septic Fee -Alteration or Rep Total: Amount S73.00 $73.00 Total Sq Feet:
o FEES PAID Inv Total Paytype Amt Paid Amt Due Inv # SEPT-J-11-20905 $ 73.00 Check # 2356 S73.00 $ 0.00 Required Inspections: Fo"o,p"o;o", "II. 1 (888)868-5306 Inspection IVR See Permit
Record Building Department Copy Thursday, March 31, 2011 2
I 2 4 5 6 7 8 9 10 II 12 13 t4 15 t6 17 108 8'h Sireet, Suile 401, Glenwood Springs, CO 81601 Ph:970-945-8212 Fx:970-384-3440 Inspection Line:888-868-5306 www.garfield-county.com SEPTIC
PERMIT APPLlCA TION Parcel No (Ihis in'7!~ 1::j's'i aJt'Jso"3.°r;.:70-945-9f3~ I Lot ~ 3 7_ L~: I Block No: Ji .A0y-s-an addrass has not been assigned, please provide CR, Hw~;et Name
& CHy) ~ legal A~Ption C/' 10 9 (;, 1l'-N, .... pUJ rN ~ \ --((;,0 I SUbt;U~1Iown~ertyown~+ M~d~~dr I </7 ~ Ph' All Ph: V", fo (ilrmt~ "" 9~~'"2tf/tJ Contracto./-.., ~ H Mailing Address
Ph: Alt Ph: ~O V0 Engineer #fJ {;a:,hc I"; Mailing Address Ph: Alt Ph: PERMIT REQUEST FOR: ( ) ' New Installation ( ) Alteration ( WASTE TYPE: \~Iling 1;6 )~nSient Use ( )Commercialor
industri' lL ( )Non-Domestic~ ( )Other -Describe ....:As=c.t:. •L 'l?J Ohd~(.',t/h 7lJ-N.k &J 2&0:1 o &.( euJ.--lC :z BUILDING OR SERVICE TYPE: Number of bedrooms Garbage Grinder ( )Yes
( )No SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN If supplied by COMMUNITY WATER, give name of supplier: OISTAINCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System? YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND CONDITIONS: Depth to 1" Ground Water
Table Percent Ground Slope TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (1505) PROPOSED: ( )Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet ( )Recycling, Polable
Use i iOther -Describe ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet FINAL DISPOSAL BY: ( )Absorptioo trench, Bed or Pit ( )Underground Dispersal ( )Above
Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Wastewater pond ( )Other-Describe Will effluent be discharged directly into waters of the state? ( )YES ( )NO PERCOLATION TEST
RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Permlation 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 further mandatory and additional test and reports as may be required by the local heallh department to
be made atld 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 here'Nith and required to be submitted by the applicant are or
will be represented to be true and correct to the best of my kno\oViedge and belief and are designed to be relied on local department of health in evaluating the same for purposes of
issuing the permit applied for herein. I further ~~:.nxElsi~.3n Isre e tion may result in the denial of the application ~ /;;;;~ any permit granted based upon said application and '""
fO~1'Vided Y la /.'" A "-SIGNATURE /D.«TE r lC\ . C~'--"'l~ '$ 7~ · oo 3 . 'Z3. ' \ STAFF USE ONLY Permit Fee: Perk Fee: Total fees: Fees Paid: ~73· 00 'tJ1b 1-3 ,"3' o:J Bf£~ Building
Permit: Septic Permit: Issue Date: '6L{2f. -~ -II-lqS5 SEPT -3-\ 1-[95tp BUitdingZ;in: DCP ~ ./~" ~~ ;7~ APP ~VAL : . D~!#