HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.earfield-county.com
TYPE OF CONSTRUCTION
® New Installation
WASTE TYPE
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
O Dwelling 0 Transient Use 0 Comm./Industrial
0 Other Describe
0 Repair
0 Non -Domestic
INVOLVED PARTIES
Property Owner: EISENSON, DAVID 2012 TRUST Phone: ( 508 ) 505-1809
Mailing Address: 453 Settlement Lane Carbondale, CO 91623
Contractor: Blu Homes, Attn: Scott Pierce
Mailing Address: 1245 NimitZ Ave, Vallejo, CA 94592
Phone: ( 720 )284-9992
Engineer: Boundaries Unlimited Inc., Deric J. Walter, PE Phone: ( (970) 945-5252
Mailing Address: 923 Cooper Ave., Ste. 201 Glenwood Springs, CO 81601
PROJECT NAME AND LOCATION
Job Address: 657 SCHOONER LANE CARBONDALE, CO 81623
Assessor's Parcel Number: 2391-294-05-015 StirlingRanch15 Rang Section: 29 Township 7
Sub. Lot Bloc.. Range: 87
Building or Service Type: Residential#Bedrooms: 4 Garbage Grinder N/A
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Type of OWTS
I21 Septic Tank 0 Aeration Plant ❑ Vault 0 Vault Privy ❑ Composting Toilet
❑ Recycling, Potable Use 0 Recycling 0 Pit Privy 0 Incineration Toilet
❑ Chemical Toilet 0 Other
Ground Conditions Depth to 17Ground water table Percent Ground Slope
Final Disposal by l>J Absorption trench, Bed or Pit ❑ Underground Dispersal 0 Above Ground Dispersal
❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter
❑ Other
Water Source & Type 0 Well 0 Spring 0 Stream or Creek 0 Cistern
❑ Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? 0 Yes 0 No
CERTIFICATION
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 department 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.
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.
hereby acknowledge that I have read and understand the Notice and Certification above as well as
have pr- 'P ed t — quired information which is correct and accurate to the best of my knowledge.
Prope ,Owner Print and Sign
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
I I 13. a v
Perk Fee:i '
EIV G
Total Fees:
t, 12 3 .
Fees Paid:
1) 12 3.00
Building Permit
¢o0 4
Septic Permit:
¢°°✓�
Issue Da
12-131 )C
Balance Due:
9
BLDG DIV: 6Ge-e-e-Le....—)/ /'8/✓r
APPROVAL DATE