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HomeMy WebLinkAboutApplicationGarfield County OCT 0 3 2n17 Community Development Department EL , CO(Th T 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PERMIT APPLICATION TYPE OF CONSTRUCTION 0 New Installation Alteration 0 Repair WASTE TYPE 0 Dwelling 0 Transient Use 0 Commf Industrial Non -Domestic 8 Other Describe Multiple Residential Apartments & RV Spaces r INVOLVED PARTIES Property Owner: 3M Investors, LLC - Deric Waller, Partner Phone: ( 970 ) 618-7035 Mailing Address: 737 Corral Drive, Grand Junction, CO 81505 Contractor: David Moore Phone: ( 970 ) 615-5244 Mailing Address: 1256 Domelby C1, Silt, CO 81652 Engineer: Boundaries Unlimited Inc. Phone: ( 970 ) 945-5252 Mailing Address: 923 Cooper Ave. Ste. 201, Glenwood Springs, CO 81601 PROJECT NAME AND LOCATION Job Address: 15 Main Street, CO 11 Assessor's Parcel ?. [fiber: 217 10100026 % Sub. Green Diamond Properties Lot 0 Block Single Family/Apartment RV, NFacilities 9 Rooms, 2 RVs Building or Service Type: 9 Laundry #Bedrooms: Garbage Grinder N Distance to Nearest Community Sewer System: 400' Was an effort made to connect to the Community Sewer System: No Type of ISDS IN Septic Tank I 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet 0 Recycling, Potable Use 0 Recycling 0 Pit Privy 0 Incineration Toilet 0 Chemical Toilet 0 Other Ground Conditions Depth to 15t Ground water table 3'. Percent Ground Slope 2r -4i Final Disposal by PI Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal ❑ Evapotranspiration I ❑ Wastewater Pond 0 Sand Filter ❑ Other Water Source & Type © Well ❑ Spring 0 Stream or Creek 0 Cistern 0 Community Water System Name Effluent Will Effluent be discharged directly into waters of the State? 0 Yes El 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. 1 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 iL 2 ` 1�1 Date OFFICIAL USE ONLY 5 je ial Conditions: 01 -is S7?z P5m&i fre-- 7z ��4l 1/4Gid- 13454F -12"13454F-12" Permit Fee: DD Perk Fee: . Total Fees: Fees Paid: /�/ 'ICr DV Building Permit otic Permit9(0 Issue Dat Balance Due: BLDG DIV: 110r A•PROV: DATE PbV$\) ?Rza ' 419xzr--)4(-- /s F 4 e S/Dvr 7 4L PR414--)i-L tiirr,4, - 3rnterC c -F?S' 4 1 3.&.fi r ., Q � ply e -42-f--•444. ' Sri Amin