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Home My WebLink AboutApplication-PermitGarfield County No. I lD190 I Building & Sanitation Department 108 8th Street, Suite #401 Glenwood Springs, Co. 81601 Office 945-8212 Inspection Line 384-5003 Job Address: 1447 Cr 108, Carbondale Locality: 2393-321-00-378 Use of Building: employee housing for ranch helper Owner: Crystal River Ranch Co Contractor: Structural assoc. Amount of Permit: septic Total $2,129.41 $150.00 $2,279.41 oate: --:--~...;...:-oo-;0_'0-==-] __ Clerk: _____.,J ........ I a=---4'T"4\..;;;_C r __ II 12 GARFIELD COUNTY BUILDING PERMIT APPLICATION I 08 8'" Street, Suite 40 I, Glenwood Springs, Co 8 I 60 I Phone: 970-945-8212/ Fax: 970-384-3470 /Inspection Line: 970-384-5003 www. garfi c 1 d-C0\!!11Y. com 0 a Detached 0 ~· This application for a Building Permit must" be signed by the Owncrofthe property, described above, or an authorized agent. If the signature below is not that of the Owner, a separate letter of authority, signed by the Owner, must be provided with this Application. Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building Department. Other Permits. Multiple separate permits may be required: (I) State Electrical Permit, (2) County lSDS Permit, (3) another permit required for usc on the property identified above, e.g. State or County Highway/ Road Access or a State Wastewater Discharge Permit. Void Permit. A Building Permit becomes nul! and void if the work authorized is not commenced within ISO days of the date ofisstmncc and if work is suspended or abandoned for a period of 180 days after commencement. CERTIFICA TlON l hereby certify that I have read this Application and that the information contained above is true and correct. I understand that the Building Department accepts the Application, along with the plans and specifications and other data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming completeness of the submittals and approval of this Application, a Btlilding Permit will be issued granting permission to me, as Owner, to construct the structurc(s) and facilities detailed on the submittals reviewed by the Building Department. In consideration of the issuance of the Building Permit, I agree that J and my agents will comply with provisions of any federal, smtc or local law regulating the work and the Garfield County Building Code, ISDS regulations and applicable land use regulations (County Regulation(s)). ! acknowledge that the Building Permit may be suspended or revoked, upon notice from the County, if the location, construction or usc of the strueture(s) and facility(ics), described above, arc not in compliance with County Regulation(s) or any other applicable law. I hereby grant pcnnission to the Building Department to enter the property, described above, to inspect the work I further ttcknowlcdgc that the issuance of the Building Permit docs not prevent the Building Official from: ( !) requiring the correction of errors in the submiuals, if any, discovered after issuance; or (2) stopping construction or usc oft he stmcture(s) or faci!ity(ics) 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 of errors, omissions or discrepancies. As the Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations rest with me £md my i'Hlthorized agents, including without limitation my architect designer, engineer and/ or builder. l HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE NOTICE& CERTIFICATION ABOVE: STAFF USE ONLY Special Conditions: Adjusted Valuation: Plan Check Fee: Permit Fee: Manu home Fee: Mise Fees: 15'2-,'l '\ ~ 1f B' 38' f(l., \ d-"l o ss-¢5 r/ ~IS:I).S~~~illi! Total Fees: Fees Paid: Balance Due: BP No & Issue Date: ISDS No & Issued Date: \ .;-06() ;ld-l4ll\ g3s .sto I ~'-\0 ss· 101-qO Lft-ID\ Setbacks: OCC Group: Const Type: Zoning: -r:;(Z. (_ BLDG DEPT: PL:~~~:T: L) l ..1 \ U}.. \2~lo~u"l I? -lr. ~ 0"7 APPR 1'\XAl, \ • DATE AP \i DATE vv t:).P ~0--c:>"' v 'Z> "'t> :1:' ,__, --u( 'l(A(o) 'II:'" II 111~ ~~~ The following items are required by Garfield County for a final Inspection: 1) A final Electrical Inspection 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 with cabinets, sink with hot & cold running water, non-absorbent kitchen floor covering, counter tops and finished walls, ready for stove and refrigerator; all necessary 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 be constructed to all IBC 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 Certificate of Occupancy may be issued conditionally. 8) A final inspection sign off by 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 (C.O.) WILL NOT BE ISSUED UNTIL ALL THE ABOVE ITEMS HAVE BEEN COMPLETED. A C.O. MAY TAKE UP TO 5 BUSINESS DAYS TO BE PROCESSED AND ISSUED. OWNER CANNOT OCCUPY OR USE DWELLING UNTIL A C.O. IS ISSUED. OCCUPANCY OR USE OF DWELLING WITHOUT A C.O. WILL BE CONSIDERED AN ILLEGAL OCCUPANCY AND MAY BE GROUNDS FOR VACATING PREMISES UNTIL ABOVE CONDITIONS ARE MET. I understand and agree to abide by the above conditions for occupancy, use and the issuance of a C.O. for the building identified in the Building Permit. VALUATION FEE DETERMINATION ""C~ry"::;s:;:ta::,l ;::Ri~·v~er;-:Ra=n:::ch,_ ______ Subdivision Applicant Address Date 1447 CR 108 Lot/Block ~1.:;:2/;6:,..:/2:;;:0:,:;07~::._--------Contractor ""s,_tructura-.,.----,1:-A:-s-so-c-. -,...------- Finished (Livable Area): Main Upper ·Lower Other Total Basement: Unfinished Square Feet Valuation Conversion of Unfinished to Finished Total Valuation Garage: Valuation Crawl Space Valuation Decks/ Patios Valuation Covered Open Type of Construction: Occupancy: Valuation Total Valuation 1183 sf 424 sf sf sf X $74.68 1607 sf sf X $41.00 sf X $33.68 371 sf X $18.00 1183 sf X $9.00 642 sf X $24.00 sf X $12.00 Commercial sf X sf X sf X sf X sf X sf X 120,010.76 0.00 6,678.00 10,647.00 15,408.00 0.00 . 152,743.76 GARFIELD COUNTY BUILDING AND PLANNING 970-945-8212 MINIMUM APPLICATION REQUIREMENTS For SINGLE FAMILY DWELLING CONSTRUCTION Including NEW CONSTRUCTION ADDITIONS ALTERATIONS And MOVED BUILDINGS In order to understand the scope of the work intended under a permit application and expedite the issuance of a permit it is impmtant 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 information 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 yonr 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. Any project with more than ten (10) occupants requires the plans to be sealed by a Colorado Registered Design Professional. 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. Plans to be included for a Building Permit, must be on drafting paper at least 18"x24" and drawn to scale. Plans must include a floor plan, a concrete footing and foundation plan, elevations all sides with decks, balcony, steps, hand rails and guard rails, windows and doors, including the finish grade line and original grade. A section showing in detail, from the bottom of the footing to the top of the roof, including re-bar, anchor bolts, pressure treated plates, floor joists, wall studs and spacing, insulation, sheeting, house-rap, (which is required), siding or any approved building material. Engineered foundations may be required. A window schedule. A door schedule. A floor framing plan, a roof framing plan, roof must be designed to withstand a 40 pound per square foot up to 7,000 feet in elevation, a 90 M.P.H. wind speed, wind exposure B or C, and a 36 inch frost depth. All sheets to be identified by number and indexed. All of the above requirements must be met or your plans will be returned. All plans submitted must be incompliance with the 2003 IRC. 1. Is a site plan included that identifies the location of the proposed structure or addition and distances to the property lines from each comer ofthe proposed structure(s) prepared by a licensed surveyor and has the surveyors signature and professional stamp on the drawing? Properties with slopes of30% or greater must be shown on the site plan. (NOTE Section: 106.2) Any site plan for the placement of any portion of a structure within 50 ft. of a property line and not within a previously surveyed building envelope on a subdivision final plat shall be prepared by a licensed surveyor and have the surveyor's signature and professional stamp on the drawing. Any structure 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 structure located within the envelope. Yes4y1--- 2. Does the site plan also include any other buildings on the property, 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 setback~do apply. Y es_l-f"=--- 3. Does the site plan include when applicable the location of the l.S.D.S. (Individual Sewage Disposal System) and the distances to the propetty lines, wells (on subject property and adjacent properties), streams or water courses? Yes X I 4. Does the site plan indicate the location and direction of the County or private road accessing the property? 2 Yes _ __,/,_ __ 5. Are you aware that prior to submittal of a building permit application you are required to show proof of a driveway access permit or obtain a statement from the Garfield County Road & Bridge Department stating one is not necessary? You can contact the Road & Bridge Department at 625-860 I. Yes )" 6. Do the plans include a foundation plan indicating the size, location and spacing of all reinforxjng steel in accordance with the IRC or per stamped engineered design? Y es___,/f-~-"'---- 7. Do the plans indicate the location and size of ventilation openings for under floor crawl spaces and the clearances required between wood and earth? Yes ;( I 8. Do the plans indicate the size and location of ventilation openings for the attic, roof joist spaces and soffits? Yes _____ _ 9. Do the plans include design loads as required by Garfield County for roof snow loads, (a minimum of 40 pounds per square foot up to & including 7,000 feet above sea level), floor loads anq )!'ind loads? Yes_-+}S.;__,.,___ __ _ I 10. Does the plan include a building section drawing indicating foundation, wall, floor, and roof construction? Yes XL 7 11. Does the building section drawing include size and spacing of floor joists, wall studs, ceiling joists, roof rafters or joists or trusses? Yes P 7 12. Does the building section drawing or other detail include the method of positive connection of all column;;ynd beams? Yes·---~~~~·----/ 13. Does the elevation plan indicate the height of the building or proposed addition from the undisturbed grade to the midpoint between the ridge and eave of a gable or shed roof or the top of a flat roof? (Building height measurement usually not to exceed 25 feet) Yes :)! 14. Does the plan include any~ ot.Zero cleam1ce flwpl~e planned for installation including 3 II certifications or phase II EPA certification? Yes X No .4111~ M#P£t: ~t> 15. Does the plan include a masonry fireplace including a fireplace section indicating design to comply with the IRC? Yes No._~""----- 16. Does the plan include a window schedule or other verification that egress/rescue windows from sleeping rooms and/or basements comply with the requirements of the IRC? Yes X No. ______ _ 17. Does the plan include a window schedule or other verification that windows provide natural light and ventilation for all habitable rooms? Yes No. ______ _ 18. Do the plans indicate the location of glazing subject to human impact such as glass doors, glazing immediately adjacent to such doors; glazing adjacent to any surface normally used as a walking surface; sliding glass doors; fixed glass panels; shower doors and tub enclosures and specify safety glazing for these areas? Yes X No _____ _ 19. Is the location of all natural and liquid petroleum gas furnaces, boilers and water heaters indicated on the plan? Yes Y No. _____ _ 20. Do you understand that if you are building on a parcel of land created by the exemption process or the subdivision process, are building plans in compliance with all plat notes and/or coxenants? Yes "-<:.(;/II) No _____ _ 21. Do you understand that if you belong to a Homeowners Association (HOA), it is your responsibility to obtain written permission from the association, if required by that association, prior to submitting an application for a building permit? The building permit application will be accepted without it, but you run the risk of the HOA bringing action to enforce the covenants, which can result in revocation of permit issued. Additionally, your Plan Review fee is not refundable if the plans have been reviewed by the Building Department prior to any action by the HOA that requires either revocation or substantial modification of the plans. Yes f"il' No· _____ _ 22. Will this be the only residential structure on the parcel? Yes No Ifno-Explain: &tJCH 6MftPVEF lllt!s;N'f 23. Have two (22 complete sets of construction drawings been submitted with the application? Yes ~ 4 24. Do you understand that the minimum dimension a home can be on a lot is 20ft. wide and 20ft. long?v Yes L_'_: No ____ _ 25. Have you designed or had this plan designed while considering building and other construction code requirements? Yes No _____ _ 26. Do your plans comply with all zoning rules and regulations in the County related to your properties zone district? Yes ....\J No _____ _ 27. Does the plan accurately indicate what you intend to construct and what will receive a final inspection by the Garfield County Building Department? Yes No _____ _ 28. Do you understand that approval for design and/or construction changes are required prior to the application of these changes? Yes No _____ _ 29. Do you understand that the Building Department will collect a "Plan Review" fee from you at the time of application submittal 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 ~ No. _______ __ r 30. Are you aware that you must call in for au inspection by 3:30 the business day before the requested inspection in order to receive it the following business day? Inspections will be made from 7:30a.m. to 3:30p.m. Monday through Friday. Inspections are to be called in to 384-5003. Yes l(, No. _____ _ I 31. 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 No. _____ _ 32. 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 No _____ _ 5 33. Are you aware that the Permit 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 IRC? Yes·----~'--No _____ _ 34. Do you understand that you will be required to hire a State of Colorado Licensed Electrician and Plumber to perform installations and hookups, unless you as the homeowner are performing the work? The license number of the person performing the work will be required at time of appliq_(!ble inspection. Yes ~ No ______ ___ 35. Are you aware, that on the front of the Building Permit Application you will need to fill in the Parcel/Schedule N~r for the lot you are applying for this permit on prior to submittal of a building permit application? Your attention in this is appreciated. Yes !C No _______ _ 36. Do you know that the local fire district may require you to submit plans for their review of fire safety issues? Yes No (please check with the building department about this requirement) 37. Do you understand that if you are planning on doing any excavating or grading to the property prior to issuance of a building pennit that you will be required to obtain a grading pennit? Yes ~ 38. Are you aware that if you will be connecting to a public water and/or sewer system, that the tap fees have to be paid and the connections inspected by the service provider prior to the issuance of a Certificate of Occupancy? Yes v .VII • I hereby acknowledge that I have read, understand and answered these questions to the ~ bes~.t y ~ "lilittyy .. (~ ~;,q~~2~~~~~z ____ ____ ' Signature of Owner Dale Phone: __________ (days); __________ .(evenings) Project Name:. ___ .....:C=.:..r-"1-Ll ""'~ka~I-~_,_~...:..V<_,~.:....~-'-~...:..~...:....='--"-"------- ~ Project Address: ____ _jl._tf.__t{-'-1_,__C=--Vl..--_to_<;t __ C-=-~-=-cZ"--"ct"-'CtC>._<\]..:... . .:...c((p'-'d-'"-3d-- Notes: If you have answered "No" on any of the questions, you may be required to provide this 6 information at the request of the Building Official prior to beginning the plan review process. Delays in issuing the permit are to be expected. Work may not proceed without the issuance of a permit. If it is determined 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 until required information has been provided and the application rotates again to first position for review, delay in issuance of the pennit or delay in proceeding with construction. Bpminreq November2006 7 PLAN REVIEW CHECKLIST Applicant (~\..L \4,1VL-Qa..j Date 12 -<.-en. Building _t6ngineered Foundation LDriveway Permit e: JG< ., t1 ~ . Lsurveyed Site Plan S tic Permit and Setbacks ~ ~ 7"1)' lrf' 0 bL-~de!fopography 30% -~_AAtttta,ch Residential Plan Review List ~Minimum Application Questionnaire ~Subdivision Plat Notes AFire Depattment Review ----\:,.LV aluation Determination/Fees ~ed Line Plans/Stamps/Sticker __ Application Signed ~Plan Reviewer To Sign Application _LParcel/Schedule No. *"-40# Snow load Letter-Manf. Hms. ~Soils Report GENERAL NOTES: Planning/Zoning /Property Line Setbacks ~Oft Stream Setbacks ~odP!ain ~!ding Height ~ning Sign-off ~Impact Fees JoAIDRC Approval ~ade!fopography 40% ~mng Issues ~ ""'f10'Q'-' ~· / !7-H· D-t"v•-(- _._..,.,.,_Sub( division Plat Notes Nlo. _ .. -'------.:.1~07'--9;_;0'----Assessor's Parcel No. 2393-321-00-378 --· <? Date ___ 1.:.:::2=/2=0=/2=0=07"-- BUILDING PERMIT CARD Job Address ----~1~44~7~c~r1~0~8~C~ar~b~o~n~d~al~e ______________________________________ __ Owner ______ ___::Cc:..ry..,s=-=ta,I~R.:=.iv:..::e::.:.r~R=a,.,n~c:.::.h_,C:.:::o ___ Address 1470 Cr 108, Carbondale Phone# 963-2244 Contractor Structural Associates Address 4185 cr 154, GWS Phone # 949-6639 Setbacks: Front ______ Rear ______ RH, _____ LH _____ Zoning ____ _ Employee housi~g f/r~nc~ helper ...... ,jg. INSPECTIONS Soils Test J-;z~-c~./~~-i/t·yt? ~.'·· ... ~;.\; .· , Weatherproofing _________ _ Footing _f-30-~$ · ~~6 if;\J.... \JWtl f""~ Mechanical Foundationet.-6-i!:i'tt ~ · _ •. ~/~~~lectrical Rough (State)_-'if}/-:rLc__ _____ _ Grout t/ _.,.£1ectrical Final (State) V c Underground Plum.bing N'//'1 . _ '7P""~inalb%"Of!r /Che. !J!Jiis om61eted? iZ Rough Plumbing t-/~~ o~ Certificate Occupancy # _,_""'7.._,--~5*""'---::=-=--- Framing ~-Lo-o~ ~ ~~ Date JS8 ;;2..(o•ffi Insulation ¥17-<J8'~ Septic System# 7' 9c/ Roofing Date G 7 \£· 11-ll-o8 Drywall t~~p-o'/r/1J1P-Final· &~;2..-ePg' ·~ Gas Piping _!j_-lo·o!J' ~ Other-------------------------- '1-lf)-ofl ~~dt~ NOTES (continue on back) COUNTY OF GARFIELD -BUILDING DEPARTMENT CORRECTION NOTICE 1 08 8th St., Suite 401 Glenwood Springs, Colorado Phone (970) 945-8212 Job located at /'flf7 C£ I CJ 8 Permit No. /o"') 90 I have this day inspected this structure and these premises and found the following ~orrections needed: gcall for Re-lnspection 0 $50.00 Re-lnspection Fee must be paid prior to Re-lnspection You are hereby notified that the above correction must be inspected before covering. When correction(s) have been made, call for inspection at 970-384-5003. 20 ---- Building Inspector ~~ Phone (970) 945-8212 COUNTY OF GARFIELD -BUILDING DEPARTMENT CORRECTION NOTICE 108 8th St., Suite 401 Glenwood Springs, Colorado Phone (970) 945-8212 Job located at IE/1(7 C-1'-< !C 7 Permit No. I 0/9'?? I have this day inspected this structure and these premises and found the following corrections needed: D Call for Re-lnspection D $50.00 Re-lnspection Fee must be paid prior to Re-lnspection You are hereby notified that the above correction must be inspected before covering. / When correction(s) have been made, call for inspection at 970-384-5003. Date 0--,1c:J ..-oR 20 --;;>'-,----===- Building Inspector ~~::>:>~--__, Phone (970) 945-8212 COUNTY OF GARFIELD -BUILDING DEPARTMENT CORRECTION NOTICE 108 8th St., Suite 401 Glenwood Springs, Colorado Phone (970) 945-8212 Job located at Jtl.l£7 Cl</03 PermitNo.~/~o~7~£,~l2~--------------------------- I have this day inspected this structure and these premises and found the following corrections needed: ~Call for Re-lnspection D $50.00 Re-lnspection Fee must be paid prior to Re-lnspection You are hereby notified that the above correction must be inspected before covering. When correction(s) have been made, call for inspection at 970-384-5003. Date J-;;.Jf-o 8' 20 -e~"'"""'-- Building Inspector ~~ Phone (970) 945-8212 INSPECTION WILL NQJ BE~MADE UNlESS THIS CARD IS POSTED ON THE JOB 24 HOURS NOTICE REQUIRED FOR INSPECTIONS BUILDING PERMIT GARFI~LD COUNTY, COLORADO. •C[ O Date Issued.J@:~~:! •..•. Zoned Area ........................ " ..... Permit NoJ.QJ ... ~ .............. .. AGREEMENT In consideration of the issuance of this permit, the applicant hereby aerees to comply with all Jaws and regulations related to the zoning, location; construction and erection of the proposed structure for which this permit is granted, and further agrees that if the above said regulations are not fully complied with in the zoning, locatiOn, erection and construction of the above described structure, the permit may then be revoked by notice from the County Building Inspector and IMMEDIATELY BECOME NULL AND VOID. Use f:\M.p 1 e\tft? )111\)'SlYlq ~t( 131 Ylr\1) t\el ~ Address or Legal Description !ULJ3-rr 1\')'l)-Q1C)Cl e Owne~ c\1,\'i>luL £1\!ll'"VflW:\1} QD Contractor3,liill·illml Cl~(X. Setbacks Front Side Side Rear This Card Must Be Posted So It is Plainly Visible From The Street Until Final Inspection. INSPECTION RECORD Footing }-30-d(, ~ <JtFer<., 0.( Driveway Foundation ;),-b-O$ ~ Underground Plumbing N'/11 Rough Plumbing 4-10-06 -'!"~- ,-Chimney & Vent u-ro-a .jjrl,t:. Gas Piping t-( /tH:l(/1¢. Electric Rough (By State (iM/f_9or) f!:717 Framing 4 -to -06f;lf'-;,,.;.,,":: J;.~. (To include Roof in place and~indciWs ~ and Doors installed). ~-ft.{~ (J'fJ/fl" ,Insulation '-1· r?· 0'(;~ Drywall q. d.?. ox~ Electric Final (by State lnspe!!Jitf-: ljf' v/f 3 198 Finai6-;;>.:S-oS ~ Septic Final,;--~-0$ ~ ALL LISTED ITEMS MUST BE INSPECTED AND APPROVED BEFORE COVERING- WHETHER INTERIOR OR EXTERIOR, UNDERGROUND OR ABOVE GROUND. THIS PERMIT IS NOT TRANSFERABLE For Inspections Call384-50.03 I 08 8th Street Glenwood Springs, Colorado 0?-.-APPROVEDDO NOT DESTROY THIS CARD '~~-:-' ~· Date B·~G-4 By -r:"'A"'"'·n~ ---. ~- IF PLA~~C~Ji:R WITH CLEAR PLASTIC / GARFIELD COUNTY BUlLQING AND SANITATION DEPARTMENT 10,,8,,.!'i~hth Stree~ Suite 201 GlenwoocPSprings, Coloradof 81601 Phone (970) 945-8212 Permit Assessor's Parcel No. INDIVIDUAL SEWAGE DISPOSAL PERMIT This d.oeS not constitute a bUilding or use permit. PROPERTY Q l\V\C IJ\ Owner's Name({ \f'-)$IL '\2\\.Y\ \ \ 1U 4 .~f ,r.,>?- System Location -l I+ \ I '0'-.c)- Legal Description of Assessor's Parcel No., _,d,_,\_:-0"'''-c.-"r"'~"-·,-:....::::)=d_~\'----'()::::._$.:::::..· _-_"'"'_:::"2l:::' :..:0-.,_,o"'-------------------- SYSTEM DESIGN --.t-2_"\;_-,;,C:,_) __ Septic Tank Capacity (gallon) :::"' 'I .-, ""eUl' c ----"''"'"-.L---Percolation Rate (minutesfinch) Number of Bedrooms (or other) .? .4"'¥'.7 t(j"ifW_.f?-[!)'d-· · RequiredAbsorptionArea-SeeAttached £/ l ~;z:.;~.n~d.:;; 3.2. 1~ Uk'~,/.tf 3"-1'' Special Setback Requirements: 301 ~,...,~fi j _,r;,; tf3~,:; 'I I ~;:z;,. a~.,!e:A' '-I 37 0 A-tf--tA·#' -e tf:.ePf Date '-f' /7 .. t7 8 Inspector -f??:;t<,.¢'/ m£-.. p':;nztf-·· FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer ../0/~ ~.4-t<.<:~:,, .• n' /; / / ,..-1 .../.. /.c ('. c#. ']' Septic Tank Manufacturer or Trade Name _Oo:'--C£t'.-"<~-,.7'2.J<"""~:.I;,:.:.,a""""'·"-'"'"~'o-'=·:._;,09,a:.!."'l:_:'I!,:;~~~:.Ae.:.<&·,__,, _ _:::\..~(:....:::~"'--;;io-L..---------(I v Septic Tank Access within 8" of surface _ _:-t,;F""-;1.""_~--------------------------" Absorption Area i{o,./! 3 Lj -t':0M·v/1i- / // Absorption Area Type and/or Manufacturer or Trade Name _,61.""':.?<-="'""'""'-'""'-"''~~--'-''+£:__~-"'-1-'C/'--------------- Adequate compliance with County and State regulationsfrequirements_c!.~¥Jc::;-S<,.,_~---------------- Other_~1L·y/~~~~1 _____________________________________________ ~------------------------ / ''<2' . »'h··7 -A/ ..,;1'7_....,. A::2 c7C: Date_Ln'-·-·· .,::;;c_.'_-:::c_..-:;•':::>==-. _______ lnspector -// ~ .;;/'// /d',/L~~ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE •CONDITIONS: 1. All 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 ac~on and revocation of the permit. 3. Any person who constructs, alters, or installs an individua"i'Sewage disposal system in a manner which involves a knowing and material variation from the terms or specifications contained in the appllcation of permit commits a Class I, Petty Offense {$500.00 fine-6 months i.n jail or both). White-APPLICANT Yellow-DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER (:d£'(~ f<.r~ ~ ADDRESS I '(7 tP c. tL I tJ I!J C bA/-(6 CONTRACTOR ~ Assve. ADDRESS 't'ISS' c.-fL !S"f ~w s PHONE f'~~ 0/'/--7 PERMIT REQUEST FOR ~W 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_~C..d!tho?lc:::~;/P1Zll!eN.~b.<l!'lfa.~""'----------Size of Lot Legal Description or Address._l,_¥_,___,_tf-'7'-----'C..,tt-=-.L/.~<0.r..*'Lr-t' --"C..'I'.k/L'-'=fJ'-"Qf{C!J(.Ptr.&wl&"'------------- WASTES TYPE: t>(DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( )OTHER-DESCruBE _____________________________ __ BUILDINGORSERVICETYPE:. _______________________ _ Number of Bedrooms ___ _::';).. __________ Number of Persons. _____ _ ( ) Garbage Grinder ( ) Automatic Washer SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL If supplied by Community Water, give name of supplier: ( ) Dishwasher ()<):SPRING ( ) STREAM OR CREEK DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:---"'.~_,,..!!!!ili?E"::~;.L-I_t-r:__ ___________ _ Was an effort made to connect to the Community System? _p.!L_ _____________ _ A site plan is required to be submitted that indicates the following MINIMUM 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: Depth to first Ground Water Table, ________________________ __ Percent Ground Slope _____________________________ _ 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: 9\> SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET( ) OTHER-DESCRIBE FINAL DISPOSAL BY: ( ) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ~ UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?_~-- PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes. _____ per inch in hole No. I Minutes ______ per inch in hole No. 3 Minutes per inch in hole No. 2 Minutes per inch in hole No._ Name, address and telephone ofRPE who made soil absorption tests:--------------- Name, address and telephone ofRPE responsible for design of the system:------------ Applicant acknowledges that the completeness of the application is conditional upon such futther mandatory and additional tests and reports as may be required by the local health depatiment to be 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. I further understand that any falsification or misrepresentation may result in the etJ:i 1 of the application or revocation of any permit granted based upon said application and in legal action for perjury as provided bylaw. Date /2;//j/J-/ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3