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HomeMy WebLinkAboutApplicationGarfield County 1 ppR 11 1dllom�ty Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-countv.com ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE OF CONSTRUCTION igj New Installation WASTE TYPE ❑ Alteration 0 Dwelling 0 Transient Use 0 Other Describe 0 Repair Jg) Comm./Industrial 0 Non -Domestic INVOLVED PARTIES Property Owner: Eastbank, LLC Phone: ( 970 ) 925-9046 Mailing Address: 710 E. Durant Ave. Suite W-6 Aspen, CO 81611 Contractor: FUSE architecture + construction Phone: ( 970 ) 618-5831 Mailing Address: P.O. Box 4525 Basalt, CO 81621 Engineer: High Country Engineering Phone: ( 970 ) 945-8676 Mailing Address: 1517 Blake Avenue, Glenwood Springs, CO 81601 PROJECT NAME AND LOCATION Job Address: 3927 CR 154. Glenwood S.rin• s CO 81601 Assessor's Parcel Number: 2185-354-15-002 Sub. Eastbank, LLC minor Lot 2 Block 2A Building or Service Type: Equine Hospital Distance to Nearest Community Sewer System: UBedrooms: Lr 111 AA._ ■ 0., _ w Was an effort made to connect to the Community Sewer System: Garbage r ' der Type of OWTS Ground Conditions 14 Septic Tank 0 Aeration Plant 0 Vault O Recyclfng, Potable Use 0 Recycling 0 Pit Privy ❑ Chemical Toilet 0 Other 4-1.11..1(t © Vault Privy Depth to 1" Ground water table 0 Composting Toilet Incineration Toilet Percent Ground Slope Final Disposal by ❑ Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal ❑ Evapotranspiration�' ❑ Wastewater Pond I 0 Sand Filter o Other S �`l il 0E4,- J .7,0+ Water Source & Type 0 Well 0 Spring . 0 Stream or Creek 0 Cistern O Community Water System Name Effluent WIII 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 far 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 ack owledge that I have read and understand the Notice and Certification above as well as ha e rovide he r-qufred information which is correct and accurate to the best of my knowledge. Prop4t'y 0 ner Print and Sign AA:AN Date OFFICIAL USE ONLY Special Conditions: fl to i p ' �, )Vii 5 .. 5R.6 4I -l4 Permit Fee � ,— PeFee: ��t�• otai Fees: 123— Fees Paid: 114 — Balance Due: Building Permit 13(M- Li 4 . •tic ' rmit. A � V Issue Date I�q I I} sFit + BLDG DIV: �:a lg —zq APPROVAL r DATE PD. c I t3. ao1 ✓#Illq , 4Ir41�'