HomeMy WebLinkAboutApplicationGurfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrsl
PERMIT APPTICATION
unity Development DePartment
108 8th Street, Suite 401
lenwood Springs, CO 81601
(970194s-82L2
www.ga rfiel d-co untv.com
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TYPE OF CONSTRUCTI.ON
E/Ñew lnstallation n Alteration tr Repair
wAsfE TYPE
EllDwelling E Transient Use D Com m./lndustria I tr Non-Domestic
E other Describe
INVOIVED P'ARTIg
Property Owner:RYAN PRATT Phone:
Mailing Address:PO BOX 1627 CARBONDALE CO 81623
Email Address : rpratt231l@gma¡l.com
Contractor: SAME As ABovE Phon e:l
Mailing Address:
Email Address:
Engineer:Phone:()
Mailing Address
Email Address:
PROJECT NAME AND LOCATION
Job Address TBD PANARAMA ÞRIVE
Assessor's Parce I NUmbef: LoTAPANARAMADRIVE crr b, PANARAMA RESERVE Lot Blo ck
Buitding or service typ", þSJ"Lr4.:ul #Bedrooms:Garbage Disposal(Y/N I f
Distance to Nearest Community Sewer System .NA
Was an effort made to connect to the Community Sewer System:NA
Type of OWTS E Sept¡cTank n Aeration Plant El vault E Vault Privy Composting To¡let
E Recycling, Potable Use lJ Recycling E Pit Privy E lncineration Toilet
E chem¡cal To¡let E other
Ground Conditions Depth to 1st Ground water table uNKNowN Percent Ground Slope
Final Disposal by [1 Absorption trench, Bed or Pit E Underground Dispersal E Above Ground Dispersal
Evapotranspiration E Wastewater Pond Sand F¡lter
E other
E well E Spring E stream or Creek E CisternWater Source & TyPe
E Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State?EYes ENo
Appllcant acknowledges that the completeness of the application is conditional upon such further
;iJ;;ä;;;;d å;ãit?;;;it"iiànlreöorts ai-mãv be req'uired by the local health de.partment to be
il;ääiåi;'i.jri;Tñ'iË";¡,iti;¡iãi ¡v it'e toéat healih department for pu.rposed.of the evaluation
of rhe application; and tïã ¡iiüánð" ot ttré peimli is subject to such terms ahd ðonditions as deemed
necessaryto insure.ornóirirlä*itt¡ rules ån¿ régulations made,.information and reports submitted
herewith and requirejiã'Ë';;b;ìii"ã ¡vitrã apit¡cant are or will be represented to be true and
correct to the best or rîËnî*Ëåää;;i'båìiãiJ'iá ãiä ¿usigned to be rèlied on bv the,local
ããôr.tr,,"ñi óf¡rìanrr ¡n'uuåiràtìñãihu sa'e fo' þurposes oi issuing th;,ff,{n[ ãå1i:ìüï:erein,
I
iuññ"i ,nOerstand that any falsifiıation or misrepresentation m.ay
application or revocation oi unV 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
L -Ll)
Owner Print and Sign Date
FÞ 1213 -oo,It I l1-
Special Conditions:
ftoviàz Øg Iè'rfuvìnø.r¿û* à¿sì
Fees Paid:
-
Total Fees:
1L7-Perk Fee:
ø--øN
Permit FeeIt9-Balance ou.'
ú
lssue Date:
'].2ß.t7Seþt¡c Perm¡t:
s?Æ-,++L+Building Permi!vt& . q?r63
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BUILDING/ PLANNING DIVISION:
Signed Approval
a
Date