HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
RECEIVE108th Street, Suite 401
Glenwood Springs, CO 81601
MAP. CI 2(W (970) 945-8212
GARFIELD yield-county.com
COMMUNITY DEVELOPMENT
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
El New Installation 0 Alteration
WASTE TYPE
0 Repair
E1 Dwelling 0 Transient Use 0 Comm./Industrial 0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner: Franklin Mountain Glenwood Springs, LLP
Mailing Address: 123 W Mills Avenue, Suite 600 El Paso, TX 79901
Email Address: rbransford@fmmep com
Phone: (915 ) 504-7151
Contractor: Divide Creek Builders, Inc Phone: (970 ) 963-555
Mailing Address: 1531 County Road 342 Sill, CO 81652
Email Address: max@dividecreekbuilders com
Engineer: All Service Septic/Carla Ostberg
Mailing Address: 33 Four Wheel Drive Road Carbondale, CO 81623
Email Address: carla ostberg@gmail com
Phone: (970 3O9-5259
PROJECT NAME AND LOCATION
Job Address: 396 County Road 136 Glenwood Springs, CO 81601
Assessor's Parcel Number: 212312200001
Building or Service Type: Residential
Sub.
Lot Block
#Bedrooms: 2 Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System: Unknown -property a sub -parcel of property that is over 530 acres
Was an effort made to connect to the Community Sewer System: No -distance is too far
Type of OWTS
0 Septic Tank f 0 Aeration Plant 1 0 Vault 0 Vault Privy ❑ Composting Toilet
0 Recycling, Potable Use ❑ Recycling ❑ Pit Privy l 0 Incineration Toilet
O Chemical Toilet 0 Other
Ground Conditions
Final Disposal by
Depth to 15t Ground water table N/A (see report)
Percent Ground Slope 5% to the S end E
Water Source & Type
Effluent
O Absorption trench, Bed or Pit ! 0 Underground Dispersal 0 Above Ground Dispersal
❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter
❑ Other
O Well , 0 Spring 0 Stream or Creek 0 Cistern
_1 I
O Community Water System Name
Will Effluent be discharged directly into waters of the State?
❑ Yes 0 No
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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 t a required information which is correct and accurate to the best of my knowledge.
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Property Owner Print f d Sign
Date
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Pe mit Fee:
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Pees Paid:
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Building Permit
Septic Permit:*��
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Issue Date: 4
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BalanceDue:
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BUILDING/ PLANNING DIVISION:
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Sign: d A. •rova� Date