HomeMy WebLinkAboutApplicationje, Garfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-countv.com
APR 15,2017
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
New Installation
❑ Alteration
❑ Repair
WASTE TYPE
XDwelling ❑ Transient Use ❑ Comm./Industrial ❑ Non -Domestic
❑ Other Describe
INVOLVED PARTIES
Property Owner: Roger & Amelia Eshelman
Mailing Address: 7378 County Rd 100 Carbondale, CO 81623
Email Address: rbeshelman@gmail.com
Phone: ( 970 ) 379-3757
Contractor: Eshelman Construction (Thad Eshelman)
Mailing Address: 7380 County Rd 100 Carbondale, CO 81623
Email Address: eshconstruction@hotmail.com
Phone: ( 970 ) 379-1506
Engineer: High Country Engineering Inc. (Dan Dennison)
Mailing Address: 1517 Blake Ave. Glenwood Springs, CO 81601
Email Address: ddennison@hceng.com
Phone: ( 970 ) 945-8676
PROJECT NAME AND LOCATION
Job Address: Cottonwood Hollow Subdivision, Lot 7, Missouri Heights, Garfield County
Assessor's Parcel Number: 2393-123-02-007 Sub. Cottonwood Hollow
Building or Service Type: single family residence
Lot 7 Block
#Bedrooms: 3 Garbage Disposal Y
Distance to Nearest Community Sewer System: none in subdivision
Was an effort made to connect to the Community Sewer System:
n/a
Type of OWTS
Septic Tank
❑ Aeration Plant
❑ Vault
❑ Vault Privy
❑ Composting Toilet
❑ Recycling, Potable Use
❑ Chemical Toilet
❑ Recycling
0
Pit Privy
❑ Incineration Toilet
❑ Other
Ground Conditions
Depth to 1Sk Ground water table no/'found at 7'
Percent Ground Slope 20%
Final Disposal by
Absorption trench, Bed or Pit ❑ Underground Dispersal
❑ Above Ground Dispersal
❑ Evapotranspiration FIT Wastewater Pond
❑ Sand Filter
❑ Other
Water Source & Type
'Well ❑ Spring ❑ Stream or Creek
❑ Cistern
❑ Community Water System Name
Effluent
Will Effluent be discharged directly into waters of the State? D Yes No
L
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.
Property Owner Print and Sign
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee: C�
Perk Fee:
Total Fees:
Fees Paid:
Building Permit
��RE-'4L -1
Septic Permit:
s _ LL( 2
Issue Dat
1p1i(0111' ,
Balanc Due
BLDG DIV:
5/11/1017
APPROVAL
DATE
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