HomeMy WebLinkAboutApplicationGarfield County
REGEIVEDCommunity Development Department
108 81h Street, Suite 401
0 & ®N Glenwood Springs, CO 81601
(970)
GARF IELDGCOUNTY ww>;arfield Gaunty.com
COMMUNITY
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
Property Owner: Robert and Dana Brownlee Phone: ((970) 977171
Mailing Address: 156 Meadow Lane, Glenwood Springs, CO
Email Address: bob@brikor.com
LC
hi New Installation 1
•
Alteration
n
Repair
WASTE TYPE
Email Address: carla,oslberg@gmail.com
PROJECT NAME AND LOCATION
Job Address: 156 Meadow Lane
n Dwelling • Transient Use
2395-021-03-018 Sub. Westbank Subdivision #3 Lot 18 Block
• Comm./Industrial
Sewer System:
• Non -Domestic
System:
Type of OWTS
El Septic Tank 0 Aeration Plant I 0 Vault 1 0 Vault Privy I Composting Toilet
0 Recycling, Potable Use
• Other Describe
❑ Chemical Toilet
0 Other
Ground Conditions
Depth to 15' Ground water table
INVOLVED PARTIES
Property Owner: Robert and Dana Brownlee Phone: ((970) 977171
Mailing Address: 156 Meadow Lane, Glenwood Springs, CO
Email Address: bob@brikor.com
LC
Contractor: AltiludeSeptic Phone: 0910) 47113°
Mailing Address: PO Box 1534, Eagle, C0 81631
Email Address: altitudeseplic@gmail.com
Engineer: CBO Inc Phone: (PM 3091259
Mailing Address: 33 Four Wheel Drive Road, Carbondale, CO
Email Address: carla,oslberg@gmail.com
PROJECT NAME AND LOCATION
Job Address: 156 Meadow Lane
Assessor's Parcel Number:
Building or Service Type:
Distance to Nearest Community
Was an effort made to connect
2395-021-03-018 Sub. Westbank Subdivision #3 Lot 18 Block
residence #Bedrooms: 4 Garbage Disposal(Y/N)
Sewer System:
to the Community Sewer
System:
Type of OWTS
El Septic Tank 0 Aeration Plant I 0 Vault 1 0 Vault Privy I Composting Toilet
0 Recycling, Potable Use
0 Recycling I 0 Pit Privy I ❑ Incineration Toilet
❑ Chemical Toilet
0 Other
Ground Conditions
Depth to 15' Ground water table
r Percent Ground Slope
Final Disposal by
0 Absorption trench, Bed or Pit 0 Underground Dispersal 1 0 Above Ground Dispersal
❑ Evapotranspiration
0 Wastewater Pond
I ❑"Sand Filter
❑ Other
Water Source & Type
0 Well 0 Spring 0 Stream or Creek 0 Cistern
El Community Water System
Name Westbank
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. 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.
/111
Property Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
13•bo
Perk Fee:
6N& .
Total Fees:
123.bv
Fees Paid:
3.
l D0
Building PermitSeptic
...-----•••Ste,
Permit:
7 o
Issue Date:.
-----
Balance Due:
BUILDING/ PLANNING DIVISION:
/..."1U
Signe. Approv I Date
P. I23. oo v 4t 2132-, 4-f 30 1$