HomeMy WebLinkAboutApplicationGørfield County
RÉCÉNÉD
www.garfield-cou ntv.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
TYPE OF CONSTRIJCÍION
tr New lnstallation E Alteration tr Repair
WASTE WPE
tr Dwelling E Transient Use EI Comm./lndustrial tl Non-Domestic
E Other Describe
INVOLVED PARTIES
Property Owner: CCC-B LLLP Phone:
Email Address;chris@ruddconstruction.com
Mailing Address:132 ParkAve Basalt, CO 81ô21
i;970 ) 927-4038 ext 4
Basalat, CO 81621
Contrector:Rudd Construction Phone:
Mailing Address: 132 ParkAve
EmailAddress:chris@ruddconstruction.com
le70 I 9274038 ext 4
945-5700
Email Address:tbeck@za-eng¡neer¡ng.com
Engineer:Zancanella and Associates, lnc.
Mailing Address: P.O. Box 1908
Phone:
1005 CooperAve Glenwood Springs, CO 81602
PROJECf NAME AND IOCAT¡ON
Distance to Nearest Commun¡ty Sewer System:
Was an effort made to connect to the Community Sewer System:
Bldg. AJob Address:0062 County Road 1 1 3, Carbondale, CO 81623
Building or Service Type:F1 Warehouse Type ll
Assesso/s Pa rcel Number: 2393-181-00-358 Sub.
fBedrooms: Garbage Disposal(Y/Nl-
Lot Block
Composting ToiletnE Aeiat¡on Plant El Vault E Vault PrivyEI SepticTank
E lncineration ToiletEI Recycling E P¡t Pr¡vyE Recycling, Potab¡e Use
EI otherE Chemical Toilet
Type of OWTS
Percent Ground SlopeDepth to lst Ground water table
-
Ground Conditions
E Underground Dispersal E Above Ground DispersalEI Absorpt¡on trench, Bed or PitFinal Disposal by
Evãootrensô¡rât¡on D Wastewater Pond El sãnd Filtel
N
Applicant acknowledges that the completeness of the application is conditional upon such further
nìandatory and additional test and reports as may be required by the local health de.partment 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
necessa'rry 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 be'st 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 a.pplie.d 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 understand the Notice and Certification above as well as
have provided the required i ich is correct and accurate to the best of my knowledge.
Eric Rudd 3119119
Property Owner Print and Sign Date
?s.ÒÞr ccl 3 ?3 t1
Special Conditionsl
Fees Paid:?s-Perk Fee:tN0 Total Fees:?t-Permit Fee:1s-
alq/rqlssue Date:Balance Due:
ø
Septic Permit:
s;,ew- grvLBuilding Permit
ØtLo- S.lC-
tlzlcor4BUILDING/ PLANNING DIVISION:
Signed Approval Date