HomeMy WebLinkAboutApplication.pdfGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
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Owner's Name ((�� Presen{t�Address
System Location ft)q \i nO 5`,, I � F �'1,�ie — Y+CV1 \j r
Legal Description of Assessor's Parcel No. 1A 1( ),' i `( V1/40:11 /-�`�� '' ( 11/4 �) Llv\
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Permit J 6: 0
Assessor's Parcel No.
This does not constitute
a building or use permit.
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SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch)
Required Absorption Area - See Attached
Special Setback Requirements:
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Date
Inspector
Number of Bedrooms (or other) /����� �`�✓GZ
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installe
Septic Tank Capacity
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Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface /-sf!%2-'
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Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name (gm,/ ,/ -"
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Adequate compliance with County and State regulations/requirements / l? -4 -
Other
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Date /(2) n 0 -7 Inspector %1 „� 74
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. An installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con-
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a
requirement of the permit and cause for both legal action and revocation of the permit.
3. Any person who constructs,alters, or installs an individual sewage disposal system in a manner which involves a knowing and material
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 f ine — 6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
°S" Ann/
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 4, �' t'�-- +�aA2c� ��' (L c—
ADDRESS lC we Cipmita sits.pa'G6-PHONE 315-;44/4—ce
CONTRACTOR .S', -w 4.7--
ADDRESS PHONE
PERMIT REQUEST FOR 90 NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town. .tr 4 T> Co) ist-
Legal Description or Address (TR( Bucg T EFS. 1 b i' i +5 4 ? Ad
Size of Lot gai
WASTES TYPE:
( ) DWELLING ( ) TRANSIENT USE
PCOMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: " .4�'e
Number of Bedrooms r Number of Persons 7_
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: >mg WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Conununity Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: & /r?r�k$
Was an effort made to connect to the Community System? P 0
A plan site is required to be submitted that indicates the following ] UM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System (septic tank & disposal field) to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
9
Depth to first Ground Water Table 6 b
Percent Ground Slope /
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