HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
RECEIVED 108 8th Street, Suite 401
Glenwood Springs, CO 81601
MAY 1 4 101$ (910) 945-8212
www. g a rf iel d- cou nty. com
GARFIELD COUNTY
COMMUNITYEVELOPMENT
i'YPE OF CONSTRUCTION
fp New Installation
WASTE TYPE
E I Dwelling
0 Other Describe
❑ Transient Use
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
0 Repair
Comm./Industrial I ❑ Non -Domestic
INVOLVED PARTIES
Property Owner: Wesley & Dasa Bryan
Phone: ((970) 549-199
Mailing Address: 45 Oak Ct Parachute, CO 81635
Email Address: todd.byran68@gmail.com
Contractor: Property Owner
Phone: ((870)549-699
Mailing Address:
Email Address:
Engineer: Dan Nordaen
M ailing Address: 2863 Texas Ave, Grand Junction, CO 81501
Email Address: norde4@bresnan.net
Phone: ( (970) 2161769
PROJECT NAME AND LOCATION
Job Address: 100 Dry Creek Rd. Parachute, CO
Assessor's Parcel Number: 240719126012 Sub. Monument Woe
Building or Service Type:
Distance to Nearest Community Sewer System:
Lot 12 Block
#Bedrooms: 3 Garbage Disposal(Y/N)YY_s
Aproxilmatety 1 mile
Was an effort made to connect to the Community Sewer System: Yes, infrastructure does not exist.
Type of OWTS
Ground Conditions
® Septic Tank I 0 Aeration Plant ❑ Vault I 0 Vault Privy i ❑ Composting Toilet
0 Pit Privy 0 Incineration Toilet
O Recycling, Potable Use
O Chemical Toilet
❑ Recycling
0 Other
iDepth to 1't Ground water table >26 feet ordepm
Final Disposal by %1 Absorption trench, Bed or Pit
Water Source & Type
Effluent
O Evapotranspiration
O Other
Gil Well 1 0 Spring
Percent Ground Slope 3.5 % Nominal
El Underground Dispersal I 0 Above Ground Dispersal
0 Sand Filter
0 Wastewater Pond
0 Stream or Creek
❑ Cistern
O Community Water System Name
Will Effluent be discharged directly into waters of the State? 0 Yes El 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 f have read and understand the Notice and Certification above as well as
have provided the r uired information which is correct and accurate to the best of my knowledge.
isle f ...,t .
P + petty Owner Print and Sign
LC/V/F
Date
OFFICIAL USE ONLY
Special Conditions:
Ott-AA/4 el4914114 4 f kod w1 s1:4blwh d
alcov-4.
PermiittFee:
Perk Fee:
Total Fees:
Fe Paid:
Building Permit
Septic Permit:
Issue Dr te:
/
,
Balan€e Due
BUILDING/ PLANNING DIVISION:
616/16
Signed Approval
Date