HomeMy WebLinkAboutApplicationI
Gurfteld County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
i Community Development Department
-, 108 8th Street, Suite 401
^-"*Glenwood Springs, CO 81601
UAY 2 6 ?017 pTol s4s-s2tz
www.sdçLd-counly.cgm
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WPE OF CONSTRUCTION
E New lnstallation E Alteration El Repair
WASTE TYPE
tr Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic
E Other Describe
INVOLVED PART¡ES
Property OWnef : BVC Wooden Deer LLC Phone: ((e7o) 618-0Þ48
Mailing AddfgSS: 235 Snow@p Circle
Email AddfeSS. craMorddes¡gnbuild@æmcasl,net
Contractor CraMord Design Bu¡ld, LLC Phone: l(e70) s63-3Þ33
Mailing AddfeSS: PO Box 1236 Carbondale, Co. 81623
Email AddfgSS. crafforddesignbuild@æmcast.net
Engi neef. Kaup Eng¡neer¡ng, LLC Phone: ((s7o)s45-S13
Mailing AddfeSS: 1 129 Grand Ave, Glenwood Springs, CO 81601
Email AddfeSS. dale@kaupengineering.com
PROJECT NAME AND LOCATION
Job Add feSS: Lot 2 Wooden Deer Road
ASSeSSOT'S PafCel NUmbet: 23e324304o02 SUb. Wooden Deer Lot 2 Block _
Building or Service Type:S¡ngle Fam¡ly Home #Bedrooms: s Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer Syste m: NA
Was an effort made to connect to the Community Sewer System:No
Type of OWTS E Sept¡cTãnk EI Aeration Plant E Vault E Vauh erivy tr Composting To¡let
E Recycling, Potable Use E Recycling E Rit Rrivy E lncineration Toilet
E Chemical Toilet E other
Ground Conditions Depth to l"t Ground water tãble +200,Percent Ground Slope
Final Disposal by E Absorption trench, Bed or Pit E Underground Dispersal E Above Ground Dispersal
E Evapotranspiration E Wastewater Pond E Sand Filter
E other
Water Source & Type E well E Spring E stream or Creek E Cistern
E Community Water System NAme Woodên Deer Community Water
Effluent Will Effluent be discharged directly into waters of the State? E Yes E fUo
qE,BÏTFTCATION
Applicant acknowledges that the completeness of the application is conditional upon such further
"iri¿ãiow ãnO a¿Uii¡onal test and reþorts as lay be required by the local health de.partment to be
mã¿ã ànO'turnished by the applicant br by the loðal healih department for pu.rposed.of the evaluation
oittéãpóllðatiınlàncíthe isöúance of thé permit is.su.bject tosuch terms and conditions as deemed
necessaiv to insuie compliance with rules ànd regulations made, information and reports submitted
tr"iı*iitr'rnd required tò be submitted by the -apþlicant are or will b.e repres.ented to be true and
còrrect to tfre beit of mv knowledge and bel¡ef ànd are designed to be relied on by the local
ãéóãñrãnt of health in'evaluatinfthe same for purposes oi issuing the permit app]ie.d for herein. I
iurtñei understand that any falsifiıation or misreþre-sentation may result in the denial of the
appliðation 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 Not¡ce and Certification above as well as
have provided the req uired information which is correct accurate to the best of my knowledge.
5126117
Property Owner Print and Sign Date
Special Conditions:
Fees Paid:lzz-Total Fees:l>4-Permit Fee:fltsa..Ø t"tn t""'EN(,
,
lssue Date:
1o.94-1};
Balance Due
É
Sept¡c Permit:
.1EIîT--¿J r+¿{ qBuilding Permit
rA?tr- qqL\A
BUILDING/ PLANNI NG DIVISION
Signed Approval Date
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