HomeMy WebLinkAboutApplicationGarfield County
ppR 1.7 Momr ity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
NI New Installation
WASTE TYPE_
0 Dwelling 0 Transient Use
r0 Other Describe
INVOLVED PARTIES
Property Owner: Eastbank, LLC
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
0 Repair
Comm./Industrial ❑ Non -Domestic
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 Springs, CO 81601
Assessor's Parcel Number: 2185-354-15-002 Sub. Eastbank, LLC minor Lot 2 Block 2A
Building or Service Type: Auto Repair
#Bedrooms: Garbage Grinder
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Type of OWTS
❑ Septic Tank 0 Aeration Plant ❑ Vault 0 Vault Privy 0 Composting Toilet
❑ Recycling, Potable Use r 0 Recycling ❑ Pit Privy 0 incineration Toilet
❑ Chemical Toilet 0 Other
Ground Conditions Depth to 151 -Ground water table Percent Ground Slope
Final Disposal by
❑ Absorption trench, Bed or Pit 0 Underground Dispersal ! 0 Above Ground Dispersal
❑ Evapotranspiration 0 Wastewater Pond I 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
iERTIFICATIORI
Applicant acknowledges that the Completeness of the application is conditional c
mandatory and l test and reports as may na!
madebe
and furnished the stad ror by the local bhealthrgdepartment h de such further
to
the andliah; the issuance applicant he permit r a such local health department
f necessary to insure andthe scwith rules and it is subjectbmade, information
dr P rtment to &c
purposed of the evaluation
herewith and required to be submitted byterms and conditions as deemed
correct to the best of my knowledge and elief and are designee to be relied on
reports submitted
applicant are or ill be represented to be
department of health in evaluating the same for purposes 0 +� by the local
further that any falsification or misrepresentation maytrue and
applic r understand r revocation of anyf issuing the permit a
as provided by law. permrt granted based upon result in the denial of ther erein, f
p n said application and legal action for perjury
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have rovlded the required information which is correct and accurate to the best
«: f of my knowledge_
f! �`■1 r•
Print and Sign
Pp
Date