HomeMy WebLinkAboutApplicationCGarfield County
Community Development Department
RECEIVED 108 8t'' Street, Suite 401
;� 14 Glenwood Springs, CO 81601
A'R (970) 945-8212
GARFIELD COUNT vw.garfield-county.com
COMMUNITY DEVELOPMENT
TYPE OF CONSTRUCTION
0 New Installation
WASTE TYPE
CI Dwelling 0 Transient Use
0 Other Describe
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
1 0 Alteration
❑ Repair
0 Comm./Industrial 0 Non -Domestic
INVOLVED PARTIES
Property Owner: Fran- klin Mountain Glenwood Springs, LLP
Mailing Address: 123 W. Mills Avenue, Suite 600 EI Paso, TX 79901
Email Address: rbransford@Fmmep com
Phone: (915 ) 504-7151
Contractor: Divide Creek Builders, Inc.
Mailing Address: 1531 County Road 342 Silt, CO 81652
Email Address: max@dividecreekbuilders.com
Phone: (970 ) 063-3555
Engineer: All Service Septic/Carla Ostberg
Mailing Address: 33 Four Wheel Drive Road Carbondale, CO 81623
Email Address: carla ostberg@gmail com
Phone: (970 -4 309-5259
PROJECT NAME AND LOCATION
Job Address: 396 County Road 136 Glenwood Springs, CO 81601
Assessor's Parcel Number: 212312200002
Building or Service Type: Residential
Sub.
Lot Block
#Bedrooms:
4
Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System: Unknown -property a sub -parcel of properly that is over 530 acres
Was an effort made to connect to the Community Sewer System: No - dislance is too far
Type of OWTS
O Septic Tank , 0 Aeration Plant 0 Vault 0 Vault Privy Composting Toilet
❑ Recycling, Potable Use 0 Recycling J 0 Pit Privy r 0 Incineration Toilet
❑ Chemical Toilet 0 Other
Ground Conditions
Final Disposal by
Depth to 1st Ground water table N/A (see report) I Percent Ground Slope $%PoI he 8 end£
E l Absorption trench, Bed or Pit 0 Underground Dispersal I 0 Above Ground Dispersal
_ I
O Evapotranspiration i ❑ Wastewater Pond 0 Sand Filter
O Other
Water Source & Type El Well 0 Spring 0 Stream or Creek 1 0 Cistern
❑ Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? 0 Yes El No
.CERTIFICATION
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Applicant acknowledges that the completeness of the application is conditional upon such further .
mandatary 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 issuanceof 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. 1
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 prov ed the required information which is correct and accurate to the best o my knowledge.
(18
Property Owner Print and Sign
Date
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Special Conditions:
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FYI 4 ti
4.12 KG.
F SR -716.71(..K 7 P -Ii,
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Permit Fee:
CO
Perk Fee:
E. r:1_
Total Fees:
C °
Fees Paid:
6
/Qr. 3
Building Permit
Septic Permit:
Issue Date: Jzo
I
Balance Due:
BUILDING/ PLANNING DIVISION:
op-
51:- ed Appf•vaI
Date