Loading...
HomeMy WebLinkAboutApplicationr(i�_ ` Garfield County Community Development Department ACEl Trfl 8th Street, Suite 401 le lwood Springs, CO 81601 (970) 945-8212 DEC 1 1 2017 www.garfield-county,com GARFIELD COUNTY - ,1V1�l p$E'F CONNTRUCTION O New Installation I WASTE TYPE 7 ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION 0 Alteration 0 Repair O Dwelling 0 Transient Use 1 0 Comm./Industrial 0 Other Describe 0 Non -Domestic INVOLVED PARTIES Property Owner: 10211 HWY 82 Carbondale, CO 81623 Mailing Address: P.O. BOX 1799 Carbondale, CO 81623 Email Address: colandmanager@gmail.com Phone: ((970) 618-2)313 Contractor: Caleb Edelman Mailing Address: P.O. Box 1799 Carbondale, CO 81623 Email Address: colandmanager@gmail.com Phone: ( (9701 618-2)313 Engineer: All Service Septic Mailing Address: 33 Four Wheel Drive Road, Carbondale, CO 81623 Email Address: carla.ostberg@gmail.com Phone: ( (970) 309-5F59 PROJECT NAME AND LOCATION Job Address: 10211 HWY 82 Carbondale, CO 81623 Assessor's Parcel Number: 2393-291-00-159 Sub. Section 29 Township 7 Range 88 Building or Service Type: ADU Distance to Nearest Community Sewer System: 1 mile Lot 1 Block L1ngNonh, #Bedrooms: 4 Garbage Disposal(Y/N) Y Was an effort made to connect to the Community Sewer System: Type of OWTS yes © Septic Tank ❑ Aeration Plant 0 Vault 0 O Recycling, Potable Use 0 Recycling Vault Privy El Composting Toilet 0 Pit Privy 0 Incineration Toilet O Chemical Toilet 0 Other Ground Conditions 1 Depth to 1s, Ground water table 168 Percent Ground Slope 2%5% Final Disposal by IE Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal ❑ Evapotranspiration 0 Wastewater Pond I 0 Sand Filter ❑ Other Water Source & Type f ID Well 1 0 Spring 0 Stream or Creek 0 Cistern O Community Water System Name Effluent Will Effluent be discharged directly into waters of the State? ❑ Yes Ii] 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. g/ff\_ Property Owner Print and Sign Date OFFICIAL USE ONLY Special Conditions: Rbvi el4 w b f 4 Iktvg iri by prior fp 5 cl iligpe co76.6 . Permit Fee: ` d I/23 • Perk Fee: E k) ei Total Fees: 9123. ©� Fee Paid. OC 41 IeR 3 . Building Permit 'W,F- l 1os2 Septic Permit: 3E`r- S'Se2 Issue Dat 1 /A i 11 Balan Due: . co BUILDING/ PLANNING DIVISION: 1 1 // r r teli4'`l Signed Approval Date