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HomeMy WebLinkAboutApplication-Site Planr' ì i. F /\J\¡/L ui¡ uJ,¿'ãU ØUf 1,,ÞlNø ffit\ll\"\ 3çrr '\{ù nity Development Department lo8 8th street, Suite 401 Glenwood Springs, CO 81601 (970194s-82t2 www.sarf¡eld-countv.com Gaffield County INDIVIDUAL SEWAGE DISPOSAL SYSTEM (tsDs) PERMIT APPLICATION .TYPE OF CONSTRT'CTION New lnstallation tr Alteration tr Repair WASTE WPE ( Dwelling E Transient Use tr Comm/lndustrial tr Non-Domestic E other Describe INVOTVED PARTIES in ll 4 Jrtmìp K Mß(a,r*t Address: t"? t26 -Tree l.-au:n Þr A Phone: (_)Property Owner: Mailing e7ôI3 +4LoSbT)rY)*on lle5-U Phone: Mailing Address: Contractor: Was an effort made to connect to the Community Sewer System: ec + Phone: ( ) Garbage erinder !þ PriileCrkfcIaþ^2 I Lot Block46r:-ôI3,INumbercel Engineer: Distance to Nearest Community Sewer System: Mailing Address: Building or Service Type:#Bedrooms: PROJECT NAME AND LOCATION Job Address: Assessoy's Pa El vault E Vault erivy tr Compost¡ng To¡letSeptic Tank E Aeration Plant E Recycling, Potable Use E Recycling E Pit Pr¡w E Incineration Toilet E Chemical Toilet E other Type of ISDS Percent Ground SlopeGround Conditions \Depth to 1"'Ground water table E Above Ground DispersalAbsorpt¡on trench, Bed or Pit E Underground Dispersal E Evapotranspiration E Wastewater Pond E Sand Filter Final Disposal by E other E Cistern\wett E spring El Stream or CreekWater Source & Type E tommunity Water System Name Effluent Will Effluent be discharged directly into waters of the State? E Yes E ltlo cERnFcATlcl.l f#rH^fr fr'$ff ffi å1*5rü$'Iffi åi',tr$fi IHH¡fifls$jN,rHäi"dHr"" $*:*lg[Jm|J,t#,Si'ffi ?i'3,H,\;mduäi;ic,*rËrmË'aË'Ëo'ñiî¡äi'ää"d*.'ì*Bd næËErv to ,nsrre æmöìiåñıîìIn rriäåd ;€ù,tlatiıhs mde, informdion ard reports s¡bmitted ;",.,3Bïffilä"'iffi*'' I hereby acknowledçthat I ha¡e read and undersand the Notice a¡d Grtificdion above æwell as have provided the required information whidt is corred and am.¡rate to the be* of my knowledç. John H. McC Ffoperty Orvner Êint md 7,Ll.bo I IoÇlt-, b ?o /l c June 8.201 Dde ^ z/1 tL.*J/ ofnclAL t¡sEcfüY f€6 7 D Total Fees.00 BdanæDue:lsseDate.Sptichrmit: -4 H.ÐGOIV: DA'IE t¡-l wl,l,aeÒ tJO'vt0,^r¡yNa,G}Iç' triøt п-e-e-_c/,/wsÊLtt1FRortY{$Ès*.ëÞp\ìS,)ÈxIìþlö'IOr'tøQ./¿€ ê ct/ ¿lNè,rU{4o'#¿ry7A êeâoîn øtcot-DFAì /e0,rt €- l¡)%?cÊ, / //PÈ,itvc e (ñKcÈ ///C,Ê_ // /