HomeMy WebLinkAboutApplicationRECE
Garfield County
Community Development Department
NOV 2 9 201! 108 8th Street, Suite 401
GARFIELD COUN Pie Glenwood Springs, CO 81601
)MMUNITY DEVEL0PMFN (970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
❑ New Installation
WASTE TYPE
❑ Dwelling ❑ Transient Use
❑ Other Describe
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
(ZI Alteration
❑ Repair
Comm./Industrial ❑ Non -Domestic
INVOLVED PARTIES
Property Owner: Anna Edgerly
Phone: ( 970 ) 927-2435
Mailing Address: 1765 Snowmass Creek Rd Snowmass, CO 81654
Email Address:
Contractor: FUSE architecture + construction Phone: ( 970 1 618-5831
anna@binbilla.com
Mailing Address:
Email Address:
PO Box 4525 Basalt, CO 81621
jlapointe@fuseacs.com
Engineer: Phone:
Mailing Address:
Email Address:
I PROJECT NAME AND LOCATION
Job Address: 17527 Highway 82 Carbondale. CO 81623
Assessor's Parcel Number:2391-333-00-016Sub. Lot Block
Building or Service Type: BARN #Bedrooms: 0 Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System: NO
Type of OWTS
Ground Conditions
Final Disposal by
Water Source & Type
Effluent
® Septic Tank ❑ Aeration Plant ❑ Vault
❑ Vault Privy
❑ Recycling, Potable Use ❑ Recycling 1-0 Pit Privy
❑ Chemical Toilet ❑ Other
Composting Toilet
❑ Incineration Toilet
Depth to 15t Ground water table
❑ Absorption trench, Bed or Pit
❑ Evapotranspiration
❑ Other
Percent Ground Slope
IX] Underground Dispersal
❑ Above Ground Dispersal
❑ Wastewater Pond ❑ Sand Filter
® Well ❑ Spring
❑ Stream or Creek ❑ Cistern
❑ Community Water System Name
Will Effluent be discharged directly into waters of the State?
❑ Yes ® 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. 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.
Ak. ,efgy
Property Owner Print and Si
V6(7,077---
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
I/
Perk Fee:
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Total Fees:Fees
(I^ i
Paid: I��
Building Permit
V(_�' !b -!D
Septic Permit:
5c171-- Cbt} (
Issue Date:
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1 v/�o�1I
Balance Due:
BUILDING/ PLANNING DIVISION:
12/11
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Signed Approval
Date
VD * 12.3-101 C[7 I1 11161