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Home My WebLink AboutApplicationGarfield County Community Development Department 108 81h Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION MAR 2 O 2017 www.garfield-cou nty.com TYPE OF CONSTRUCTION ~ 0 New In stallat i o n J o Alteration l .!J Re p ai r WASTE TYPE 1721' Dwelling I 0 Transient Use I D Comm./lndustrial I D Non-Domestic D Other Desc ri be INVOLVED PARTIES --~ Pr operty Owner: 5 -tPt7 _.,, ( A' 'T1 ...-[> n/.p.a--Phone : ( ) ;>~~ ;;.,?:? Mailing Address : "-~~ ~:) , ?t?f._{?#( ~A~·t:4v7-t? ~,,,._ 'l/ri" 1.5°' I ~ Contractor: Phone : ( ) Mailing Address : - Engineer: Phone: ( ) Mailing Address : PROJECT NAME AND LOCATION _;. ..... / Job Address: t:, Z! 7 I ~tf' r 1v r Assessor's Parcel Number: Sub. Lot Block -- Building or Service Type: kti'/-12 #Bedrooms: _.? Garbage Grinder_ Distance to Nearest Community Sewer System: Was an effort m ade to connect to the Community Sewer System : / Type ofOWTS ~"Septic Tank I D Aeration Plant I D Vault -1 D Vault Privy I D Composting Toilet D Recycling, Potable Use D Recycl i ng I D Pit Privy I D Incinerati on Toilet D Chemical Toilet D Other Ground Conditions Depth to 151 Ground water table I Percent Ground Slope Final Disposal by B'" Absorption trench, Bed or Pit J D Underground Dispersal I D Above Ground Dispersal D Evapotranspiration D Wastewater Pond 1 D Sand Filter D Other J Water Source & Type 13'Well J D Spr i ng I D Stream or Creek I D Cistern D Community Water System Name / Effluent Will Effluent be discha rged directly into waters of the State? D Yes W 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 . 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 th~n..w.hieh ·s-co-ffect and accurate to the best of my knowledge. &~~.Fe~~- Property Owner Print and Sign Date OFFICIAL USE ONLY ,3--l )-2tJJ7 DATE I Account# 143304 Evelyn Scott 6373 309 Rd PARACHUTE CO 81635 Service Date 02/23/17 PO # Invoice Roto Rooter Plumbing P.O. Box 1800 Glenwood Springs CO 81602 970-945-5519 FAX: 970-243-8794 Service At: Sean Patterson 6433 309 Rd Invoice# 390312 Date: 02/23/17 Page# 1of1 PARACHUTE CO 81635 Job# 302476 Contract# Claim# Main line back up pulled toilet retreive<l feminine hygiene and cleared grease biockage drain now flowing well. Camered abs to plastic into tank good condition at this time.no warranty due to access. Description Of Service Quantity Unit Price Extended Price Tax EVALUATION FEE $29.00 $29.00 Inside/Toilet access/Main Level/3 to 4 inch $359.00 $359.00 Total $388.00 2/23/2017 Payment $388.00 Balance Due $0.00 Paid in Full. We appreciate your business! Work Authorized .__W_o_rk_A_.__._pp-'ro'-v_e_d ________ _ BOID- ~!!:!'· ;,c \ " :·· --- CUSTOMER NAME ~QA ... ~11-e,rS/:)Q_ ADDRESS ~ t/35B!llf · £12 3 oj CITY, STATE, ZIP ./Jmc)iuk.-Lb 8/_~3S PHONE 92~ -J&ic 61./1!62 FAX ASPEN 970-925-1833 CARBONDALE 970-963-2521 . GLENWOOD 970-945-5519 DATE j-/J /7 I RIFLE 970-625-4484 GRAND JUNCTION 970-243-0049 JOB# .. IO!cROtX INV.# ____ TECH ._.#~~ -WORK DESCRIPTION decv1'c.~ d~l/c ./cvzA A?~a ~ ciC>OO ..,q//Q() s ADDITIONAL WORK AFTER INITIAL QUOTE _________________ _ PART # DESCRIPTION QlY. PRICE PART # DESCRIPTION QTY. PRICE PART # DESCRIPT ION QTY. PRICE ~,--_, PRICES TOTA~ $ TOTAL s TOTAL s I$ I FUEL I SUPPLIES I EVALUATION FEE 1$29. 00 I JO B T OTAL ........................................ ~ ..................... 1$ '(c21~ I Work has been completed to my satisfaction X---------------------~- I CC# _____________ EXP. ____ VCODE __ .t# ____ 0 CASH___ l<t REMIT TO: