HomeMy WebLinkAboutApplicationGarfield 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
004577 CR 137
GLENWOOD SPRINGS, CO 81601-
211918100040
Owner Information Address
4577 CR 137 Joel & Kathleen Trueblood Glenwood Springs CO 81601
Contractor!s) Phone
Proposed Construction I Details
Converting orig storage area to S/F residence, See
orig BP# 6896,
FEES DUE FEES PAID
Primary Contractor
Valuation:
Total Sq Feet:
Section Township Range
18 5 89
Phone Cell '
9703799834
Required Inspections:
Fo> lnspeotlooo ooll' 1 ( 970 )384-5003
Inspection IVR
$0.00
0 See Permit Record
Amount lriv Total Paytype Amfpaid Am! Due
Percolation Test
Septic Fee· New
Total:
Wednesday, November 4, 2009
$100,00
$73,00
$173.00
lnv # SEPT-10-09-19857
$ 173,00 Check# 270 $173,00
$0.00 Building Department
Copy
2
GARFIELD COUNTY SEPTIC PERMJT APPLICATION
108 8" Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 I Fax: 970-384-3470 I Inspection Line: 970-384-.5003
www.rrarfield~countv .com
1 P~l ~~:~is ~oj[B t ~ai(?Qhe ~er) 4 0 s4s-9134l
2
J457s7 an adc:·~~o~e+:signeR:Ap~de Y'37 Street c:.\&~~o;:d;~:tp:S'Pcr <; • co.
3 Lot Size: · Lot N6: Block No: 'Subd.r Exemption:
2. .4 7 qe.rc:.s
4 Owner: (property owner) Mailing Address Ph: Alt Ph:
::foe! Jrve.b I ood. 4~77 C. R. I?> 7 . Ckie.t.~WoJ ''17D) 3 7 -=t -<t B :,..j
5 ~ct~f-bl ,J Mailing Address "l'h: AltPh: oe. /r'v~ oo
6 Engineer: Mailing Address Ph: AltPh:
7 PERMIT REQUEST FOR: ()() New Installation ( ) Alteration ( ) Repair
8 WASTE TYPE: ~Dwelling ( )Transient Use ( )Commercial or industrial ( )Non-Domestic wastes ( )Other-Describe
9 BUILDING OR SERVICE TYPE: '5o,._, I" -no."" .I ~ D,vel ...,c,
Number ol'bedrooms J' ._,
Garbage Grinder ( )Yes MNo
10 SOURCE & TYPE OF WATER SUPPLY: p{)WELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN If supplied by COMMUNITY WATER, give name of supplier.
11 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: !S" .,_. i le"S>
Was an effort made to connect to the Community System? #...10
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSU~D WITH OUT A SITE PLAN
12 GROUND CONDITIONS:
/00 -Ct--Depth to 1" Ground Water Table Percent Ground Slope
13 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
~Septic Tank ( )Aeration Plant ( )Vautt ( )VauiiPrivy ( )Cornposting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chernical Toilet i \other-Describe
14 FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit (X)Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Wastewater pond ( )Other-Describe
15 Will effluent be discharged directly Into waters of the state? ( )YES (X) NO
16 PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation 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 additional test and reports as may be required by
the local health depart~ent to be made and furnished by the applicant or by the local h~alth departm.ent for purposed of the evaluation of the application; and the
issuance of the perm1t IS subject to such terms and conditions as deemed necessary to msure comphance w1th rules and regulations made information and
reports submitled herewith and required to be submitled by the applicant are or will be represented to be true ~nd correct to the best of m/ knowledge and belief
and are designed to be relied on by the local department of health tn evaluating the same for purposes of .rssumg the permit applied for herein. 1 further
understand that any falsification or m1srepresentat1on may result m the demal of the applicatiOn or revocation of any Permit granted based upon said application
a~alactio_~~ 2 ~ GQ. . /_0-7 -Z.ov
OWNERS SIGNATURE DATE
Ch--bt-270 <:po~n3_jj. f.DCj STAFF USE ONLY
Permit Fee: Perk Fee: Total fees: huilding Permit#: f£3.DU f(J().c{) ('/), dD -(:l.,t...(t{
Septic Permit#: Issue Date: //. f.O~ -\345
Building & Plannin?~ /J) // -jj{j. 07
APPROVAL ' ,7--" DATE