HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 81
h Street, Suite 401 ·
Glenwood Springs, CO 81601
{970) 945-8212
www.garfield-countv.com
TYPE OF CONSTRUCTION
• • ~ If
; ONSITE WASTEWATER .
. . ·, TREATM£NT SYSTEM ' .
(OWTS)
. PERMITAPPLICATION
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ii New Installation I D Alteration l D Repair
WASTE TYPE
I D Comm/Industrial l o Non-Domestic
INVOLVED PARTIES
Property Owner: Travis Stewart Phone: ( 910 ) 963-2295
Mailing Address: PO Box 1319 , Carbo ndale. co 81623
Contractor: Clearw a1er Cons1rucilon Management. John Blatz Phone: ( 970 ) 379.3709
Malling Address: Carbondale . co 81623
---------·-Engineer: High Coun try Engineering, Inc Phone: ( 970 ) 945-8676
Malling Address: 1517 Blake Avenue , Suite 101. Glenwood Springs. co 81601
PROJECT NAME AND LOCATION
Job Address: 13 Silver Spruce Drive, Carbondale, CO 81623
Assessor's Parcel Number: 239336319004 Sub. Roaring Fork Preserve lot 4 Block --
Building or Service Type: Residentiat #Bedrooms: s Garbage Grinder _
Distance to Nearest Community Sewer System: NA
Was an effort made to connect to the Community Sewer System: NA
TypeofOWTS Iii Septic Tank I D Aeration Plant I D Vault I D Vault Privy I D Composting Toilet
0 Recydlng, Potable Use a Recydlng I D Pit Privy I D Incineration Toilet
I a Chemical Toilet 0 Other
Ground Conditions I Depth to 1" Ground water table sroe1 j Percent Ground Slope , ~%
Final Disposal by I Ii Absorption trench, Bed or Pit I D Underground Dispersal j D Above Ground Dispersal
I D Evapotransplratlon D Wastewater Pond I Iii Sand Riter
D Other Mouoded Sand Filler woth-Cho-in T-.
Water Source & Type I Ii Well -~· Spring D Stream or Creek I D Cistern r·-----------------
·--
. D Community Water System Name
I Effluent" Will Effluent be dlstharged directly into waters of the State? 0 Yes Ii No
CERTIFICATION -.=J
Applicant acknowledges that the completeness o ftlie application is conditional upon such further
1 mandatory and additional test and reports as may be required by the local health department to be
I 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 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 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.
" 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 action for perjury
as provided by law.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided t e required information which is correct and accurate to the best of my knowledge. \,.
Property Owner Print and Sign -r'ieJNat 4, t'~ Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee: Perk Fee: Total Fees:
7J ,. $Ji
BuJldlng Permit Issue Date:
BLDG DIV: -d-'"-..._.-~-__,,· ~·z::e::¥~~+-~----~~
APPROVAL
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~102.'6.~
DATE I
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