HomeMy WebLinkAboutApplicationGarfield County
J7ommunity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
14 New installation
WASTE TYPE
❑ Dwelling
1 ❑ Transient Use
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
0 Repair
0 Comm.11nddustrial 0 Non -Domestic
¢�I Other Describe
INVOLVED PARTIES
Property Owner: Robert Macgregor 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: All Service Septic
Phone: ( 970 ) 309-5259
Mailing Address: 33 Four Wheel Drive Rd. Carbondale, CO 81623
PROJECT NAME AND LOCATION
Job Address: 3925 CR 154. Glenwood Springs, CO 81601
Assessor's Parcel Number: 2185-351-15-002 Sub, Eastbank Parcel 2 Lot 2 Block 2B
Building or Service Type: Storage, Art Studio #Bedrooms: 0 Garbage Grinder 0
Distance to Nearest Community Sewer System: NA
Was an effort made to connect to the Community Sewer System:
Type of OWTS
Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet
❑ Recycling, Potable Use , 0 Recycling 0 Pit Privy 0 Incineration Toilet
❑Chemical Toilet ❑ Other L
Ground Conditions Depth to e Ground water table
Final Disposal by
Percent Ground Slope
Absorption trench, Bed or Pit 0 Underground Dispersal Ili Above Ground Dispersal
❑ Evapotranspiration ❑ Wastewate Pond 0 Sand Filter
❑ Other F'P h 1t ]
Water Source & Type 0 Well ❑ Spring 1 0 Stream or Creek 0 Cistern
0 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. 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.
1 hereby acknowledge that I have read and understand the Notice and Certification above as well as
have p ovi.ed e required information which is correct and accurate to the best of my knowledge.
Prop
wner Print and Sign
Date
OFFICIAL USE ONLY
Specjal Conditions;
r� 4 t
Permit Fee:
I23
Building Permmlt
BLDG DIV:
TQ avklea9-44-t.?-1 SC/
F$rk Fee: Total Fees:
eN6• 123 -
Septic Permit:
APPRO L
M*114.O0/ 641VIIS(r,41I1-I14'
Issue Date 1
Fees Paid:
114.
Balance Due:
411 8 -2Q)
DATE