HomeMy WebLinkAboutApplicationGurfield County ONSTEWASIËWATER
TREATM ENT STSIEM
(o\/TS)
FEFTVI IT AFHICATION
RE C E IVE ff mmunity Development Depart ment
108 8th Sreet, S.lite401
ApR I 4 l¡l11 Glenwood $rinss, æ81601
cA R F I E L D . o u *rr*** f#Ì"?Í-uJu'Íl *,,n
COMMUNITY DEVELOPMEN
r
TYFEOFæI{STFUCNCNI
New ln*allation Alterdion
Non-Domedic
WASÍETIFE
Ømm./lnduSrialDrydliTransient Use
her Describe
IIWONfÆDPARNES
Property Oruner:Aspen Polo Pa ners LLP Phone: ( 9
MailingAddress:715 West Main St. ,Suite 20I, Aspen, Co
EinailAddress: gary@wrigh tlawaspen. com
ômmunity Water $stem Name
Divide Creek Builders, Inc Phone:l szo ) 963-3sss
1531 County Road 342 Si1t, CO 8L652
max@dividecreekbui f ders . com
Contrador
MailingAddress:
EinailAddress:
Phone:(97O)340-4130
Hiqhwav
Enqineeri
Einail Address: TyIers@rf enq. biz
h$neer:Roaring
Mailing Address: 5 92
ork
133 Carbondale. CO
Wasan effort madeto conned to the Ocmmunity Swer STstem:
a
Building or Srvice Type:Residential
Didanceto Neare$ Ocmmunity $wer $r$em 1,.75 míles
AIEffi'EÞarcel Number: 23 91'31 1 0 0 03 3 Srb.
AV Carb e, CO.bbAddress: 764LL H
Lot _ Eock
Yes, but Lo expensive
FRO.Egf l{AM EAI\¡D IOCATI Chl
#Eedrooms: 9 Garbaç Diçosal(Y/N)-
Other
Vault frivy
Ptt Privy
SpticTank Aeration Hant
Fbcyding, Fotable Use FÞcyding
Vault QcmpoSingToilet
lncineration Toilet
Chemical Toilet
Type of O\^n'rS
2*,Èrænt Oound Sope 1%rDepth to 1d tound eel-watertable >8 fGound Ønditions
lËJ Underground Dspersal lËl Above tound Dspersal[lAbsorption trendr, Bed or Ftt
Other
WaSewater Fond $nd Frilter
Sream or Oeek Ostern
Evapotranspiration
$ringWell
Fnal Diçosalby
Water Scurce& Type
Effluent Wll Effluent be disúarged diredly into waters of the Sate?Yes No
Aoolicant acknowledqesthat the æmpletenessof the application isoonditiona! upon sud'l further
niänOãorv anO aOOitionat te$ and reöorts as may be reiq'uired by the local health department to be
mäeãiO'tuinidred bv the applicant br by the local health department for purpoæd of the evaluation
otiäe äoót¡cation: and the isiúanæ of thé permit is sr.rbjed to sucfr terms ahd ðonditions as deemed
ñè¿bssaiüiı íñsgieoomplianæwith rulesänd regulatiohsmade, information and reports$bmitted
i-ieierr-,¡ifíaìrï required tö be submitted by the apÞlicant are or will be repreænted to be true and
coireC io ffrè behi of my knowledç and belief änd are dedgned to be relied o.n by the,local
ðéóartineñiót-frãaliniríevaluatinjthesameforpurposolissringthe.permita¡ipliedforherein. I
tuTfrei uñOei$ánd that any falsifiıation or misrepresentation maylesrlt in the denial of the
âöòi¡catióri ór ievocationof any permit granted kiaæd upon said ãpplication and legal adion for perjury
abþrovided by lanr
I hereby acknowledç that I have read and under$and the Notioe and Grtification above aswell as
have the red information whiú is oorred and aoctlrate to the bed of my knowledç'
F
Property Oryner Rint and Sgn Date
al Oonditions
Ëes e.É
Fees ooÞrk Fee:it Þe:@ö
Due:ooÈrmit
*8^;ct7BUII.DINg H.ANNING
Date