HomeMy WebLinkAboutApplicationAUG 2 2 70
Garfield County
Community Development Department
108 8h Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
TYPE OF CONSTRUCTION
New Installation
WASTE TYPE
❑ Alteration
❑ Repair
Dwelling 0 Transient Use 0 Comm./Industrial 0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner: b.*7 1 - \
Phone: 070 ) 9th -3557
C
Mailing Address: 977 C R- lO1
Contractor:
S J\e- 5e rT\( \LLC.
Mailing Address: 5'22_ WF -
Engineer: kik, V2JC
Mailing Address:
Phone: (9 70)
PROJECT NAME AND LOCATION
Job Address:
Phone: (7&) -A-
8tLz3
Assessor's Parcel Number: 246,37021,15-1: Sub.
Building or Service Type:
Lot c3 Block
#Bedrooms: J Garbage Grinder_,-_
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Septic Tank 0 Aeration Plant 0 VauIt 0 VauIt Privy 0 Composting Toilet
❑ Recyding, Potable Use 0 Recyding 0 Pit Privy 0 Incineration Toilet
❑ Chemical Toilet 0 Other
Ground Conditions Depth to 1`= Ground water table Percent Ground Slope 3.----=+,%
Final Disposal by Xi Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal
❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter
❑ Other
Water Source & Type Web 0 Spring 0 Stream or Creek 0 astern
❑ Community Water System Name
Will Effluent be discharged directly into waters of the State? 0 Yes 0 No
Type of OWTS
Effluent
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. I
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 the required information which is correct and accurate to the best of my knowledge.
Prop
y Owne
..� ("L
rint and Si n
j24/
Date
OFFICIAL USE ONLY
Special Conditions: j h.w1r4 _. wife., (-cj
'o rzf rl 3.e 4f NA:+ I W p-�+��tif " /(
totp 4 ..i 4 (phtoS,9pt' c) viu yy� JxiOv
k+ 1'J0 .0 tf (5).
Permit Fee:
123'MD
Perk Fee: fir/
' &
Total Fees:
1-)-3
Fees Paid: --77
143.
Building Permit
gaze-��
'
Septic Permit:
43
Issue D e
I IIte
I co
Balance Due:
BLDG DIV:
'
4/14 ilia
APPROVAL DATE
vvt23, ,/* -34, .41L l ►0