HomeMy WebLinkAboutApplication+Gay°/veld County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
I] New Installation
0 Alteration
0 Repair
WASTE TYPE
0 Dwelling
0 Transient Use
I 0 Comm./Industrial 1 0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner: Colorado Energy Systems
Mailing Address: 274 Mountain Shadows Dr, Glenwood Springs, CO 81601
Email Address: ian@coloradoenergysyslems.com
Phone: (970 ) 456-4601
Contractor: Colorado Energy Systems
Mailing Address: 274 Mountain Shadows Dr. Glenwood Springs, CO 81601
Email Address: ian@coloradoenergysystems.com
Phone: (970 ) 456-4601
Engineer: Boundaries Unlimited Inc
Mailing Address: 923 Cooper Ave. Glenwood Springs, CO 81601
Email Address: bruce@bu-inc.com
Phone:. (970 ) 945-5252
PROJECT NAME AND LOCATION
Job Address: 1140 Devereux Rd
Assessor's Parcel Number: 21850548011
Building or Service Type: Commercial
Distance to Nearest Community Sewer System: 3/4 mde
Was an effort made to connect to the Community Sewer System:
Sub. Westglen Industrial Park
#Bedrooms: 0
Type of OWTS
Lot 11 Block 1
Garbage Disposal(Y/N) N
yes
0 Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy 0 Composting Toilet
❑ Recycling, Potable Use
❑ Chemical Toilet
O Recycling 0 Pit Privy 0 Incineration Toilet
0 Other
Ground Conditions
Depth to lst Ground water table No water detected (9'pil) Percent Ground Slope max 2-5%
Final Disposal by 0 Absorption trench, Bed or Pit
O Evapotranspiration
❑ Underground Dispersal 0 Above Ground Dispersal
O Wastewater Pond 0 Sand Filter
O Other
Water Source & Type 0 Well
Effluent
0 Spring 1 0 Stream or Creek 1 0 Cistern
O Community Water System Name City of Glenwood Springs
Will Effluent be discharged directly into waters of the State?
❑ Yes 0 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.
X044.; .may 3/29/2019
Property Owner Print and Sign
Date
OFFICIAL, USE ONLY
S edal Conditions: r'-- r
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ermit Fee:
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Perk Fee.
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Total Fees:
/23.00
Fees Paid:
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Building Permit
Septic Permit:
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sue Date: i i
Balance Due:
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BUILDING/ PLANNING DIVISION:
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Signe, • pprova
Date
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