HomeMy WebLinkAboutApplication - PermitProject Address
Garfield County
Building & Planning Department
1 08 8th Street Suite 401
Glenwood Spr¡ngs, CO 81601-
Phone: (970)945-8212 Fax: (970)384-3470
Parcel No.Subdivlslon Section Township Range
lssue Date: 512512012 Expires: 1112612012
1537 Hwy {33
CARBONDALE, CO 8I623.246303200007
Owner lnformation Address
co
Golin Chapman (970)379-6696
Contractor(s)Phone Primary Contractor
Proposed Construction / Details
New installation
Valuation:
Total Sq Feet:
$ o.oo
0
FEES DUE FEES PAID
lnv Total Paytype Amt Paid Amt Due
lnv # SEPT-5-12-21907
$ 73.00 Credit Card $73.00
$ o.oo
Required lnspections:
For lnspect¡ons catl ' I (888)868-5306
lnspection IVR
See Permit Record
Building Department
Gopy
Fee Amount
(
Septic Fee - New
Total:
$73.00
$73.00
2Friday, May 25,2012
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108 8th Street, Suite 401, Glenwtod Springs, CO 81601
Ph:970-945-82 I 2 Fx: 970-384-3440 Inspection Line:888-868-5306
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SEPTIC PERMIT APPLICATION
I Parcel No: fthis íntornation is ava,lable al fhe assossors oftiæ 970-94*9134)A4l< :ó -J- -*--¿ø7 Lot Size:
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Lot No: Block No: Subd./Exemption:
2 Job Address: 1,r afl address has nof óeen asslgned, p/ease provide CR, HWY or Street Name & CW) or and legal description
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4 Owner: þrope¡ty ownel
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Mailing Address
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Mailing Address /Ph:
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6 Engineer: rl)orro Åmrlor¿¿.11
Mailino Address
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7 PERMIT REQUEST FOR:y) New lnstallation ( ) Alteration ( ) Repair
8 WASTE TYPE:( )Transient Use ( )Commercial or industrial ( )Non- Domestic wasles
9 BUILDING
of bedrooms p Garbage Grinder ( )Yes h)No
l0 SOURCE & TYPE OF WATER SUPPLY:fr)WELL ( )SPRING ( )STREAM oR CREEK ( )CISTERN
lf supplied by COMMUNITY WATER, give name of su
11 DISTANCE TO NEAREST COMMUNITY SEWER
Was an effort made to connect to the Community System?*/e<
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
t2 GROUND CONDITIONS:
Depth to 1"t Ground Water T Percent Ground
r3 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS)PROPOSED:
Use
( )Aeration Plant
( )Recycling, other use
( )Vault( )Pit Privy
( )Vault Privy( )lncineration Toilet
( )Composting Toilet( )ChemicalToilet
14 FINAL DISPOSAL BY:
þl)Absorption trench, Bed or Pit
( )Wastewater pond
( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
( )Other- Describe
15 Will effluent be discharged directly into waters of the state?( )YES ( )N0
16 PERCoLATIoN TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Name, address & telephone of
Minutes lá, 3 per inch in hole No.1 Minutes Æ, ãí per inch in hole No.3
Minutes 7,3 per inch in hole No.2 Minutes - , per inch in hole No.
RPE who made soil a¡sorpt¡ån täsì:.o^.. ì,- tlr"'i)ì E¡7t",*7gu', àrlr','L[" ¿" tza?¿'t"g¿t
Name, address & telephone of RPE responsible for design of the system: /l ¿t
t7
and legal by law
DATE
USE ONLY
FeesPaid:-..
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Balance due:e*Total fees:D'o-77,'frii"ry Perk Fee:
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Issue Daté:e/zsrTSeptic Permit:
a? Fl- v5l7Building Permit:
& Planning
APPROVAL DA
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