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HomeMy WebLinkAboutApplicationRepair 0 Non -Domestic Dillit_qt_irfield County Community Development Department �ol6 SEP 2 8 108 Stn Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 wwwa rfi e ld-co u nty. co m ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE Of CONSTRUCTION I ® New Installation WASTE TYPE 0 Alteration ❑ Dwelling 1 ❑ Transient Use • 0 Comm./Industrial ® Other Describe Accessory Dwelling Unit INVOLVED PARTIES Property Owner: Brett Leable Mailing Address: 727 County Rd. 120, Glenwood Springs Phone:( 970 j 401-3743 Contractor: Hammerhead Operations Mailing Address: 727 County Rd 120, Glenwood Springs Engineer: All Service Septic Mailing Address: PROJECT NAME AND LOCATION Job Address: 727 County Rd 120, Glenwood Springs Phone: ( 970 ) 401-3743 Phone: { Assessor's Parcel Number: 2187-192-02-017SUb.Lookout Mtn Ranches Lot 17 Block Building or Service Type: ADU #Bedrooms: 2 Garbage Grinder Y Distance to Nearest Community Sewer System: Many Miles Was an effort made to connect to the Community Sewer System: Yes Type of OWTS ® Septic Tank 0 Aeration Plant d Vault 0 Vault Privy © Composting Toilet 0 Recycling, Potable iise ❑ Re cl ry , g ty Ing ': D Pit Privy D incineration Toilet D' Chemical Toilet { ©Other Ground Conditions 1 Depth to 1' Ground water table >100' Percent Ground Stops 5% Final Disposal by ® Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal 0 Evapotranspiration 10 Wastewater Pond , 0 Sand Filter Water Source & Type Effluent ® Well I 0 Spring Jo Stream or Creek i 0 Cistern J D Community Water System Name •Will - Effluent -be :.discharged'cllrectly Into waters of the State? 0 'Yes I2iNo WY i V. Y N'Ac.1A. WI 49104 Plkek 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. Property Owner Print and Sign Date an t se -. zW , rx`os ¢ ,9,1 ' ,,, s''A,„1,,,-, lu l=�''^ ,'•s.. u-.. m l'A9 t .r:v i . '� C [• $ ln. . W . •.rl ' ;!... ,.t .at.. .:1+1. ',-1 1�! �' . •.Ir•• �>s,.l '1.'.+: ��. r. i i'.�;'lirael�:'i•;::�:?•.�.:lNi '1':',. 1 H .t.'L , yi.i�� . .'�.t.l ...tit �r•�'.•, ��V•.i. . ,i :.� .La�":1'� . :'.+t.t •".!+ ..L,.,:' i r:. .� ..'1•.. .). ,. :. �r ;fix' +`'''�+'•+c� .1 L' ' 1Y , ,,�1�1 .1 y ��q.�� t ., i�.; `.,+!S' .0 : Wit ]`:1' + . 46, L ; •5� .I �itL.t:�j'5 a%,�C„�1,M�1i94.1�hW11 H�L1�1�1�AiN1 �tali,'J�ltik'.5 11!1,;K+.'i1}!r�Qt,L�,rvb1i113°li t tt �. ,;tli :4 r�?R1 L 'L' It Special Conditions: Permit Fee: Perk Fee: /1, Total Fees: le? .6-0 Fees Paid: 12.60 I • 09 - Buildingng�P/ermit Bu YV2e Septic Permit:i r (l4;Q5 Issue Date: fN Balance Due: digit ���` r /1-/-20/8 BLDG DIV: ` • PPROVAL DATE Pd.1233YD, 1013) 11-2-%1*