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HomeMy WebLinkAboutSeptic Permit FileINDIVIDUAL SËWAGE DISPOSAL PËRMIT PISOPFR-¡Y Owner's Nåm0 GARËIELD COUNTY BUILDING AND SANITATION DIPARTÍVIENT Permit 47tS Assessor's Parcel Na This does not consiitute abu or use permit. PresentÂdd,"nt 7ãZ{ C'r{ ,3 / Z Phone æ*Fz?:s 108 Eíghth Street, Suíte 401 Glenr¡¡ood Springs, Coforado B1 601 Phone (970)945-8212 Systenr Locaiion Legal Descrip.iion of Assessor's Parcel No SYSTËM OESIEN <2 '>'2¿25*> //f#râ Sepiic Tank Caperci.'Y (ç¡allon) -:) ¿;t Percolaiion Raie (rnirruies/inch)Number ol BecJrooms (oroiher) *:&= -e( ff /4/ ftí/fi:/{* -s*/ Oiher Required Absorpiion Area - See Aäached Sp*cial Seiback Requirements:7Z/ -sç,tr1/û(8ø/;-i* é,/ q*f_þet 4)- fo narc - ¿þ lnspector \-F'"**J ./.¿ t, t Ç r'> a/ Í:til11 I qvqïËn/f lÂlqÞtr Ì-t o t\l i1 hln ¿1 ÞtrÞfì1/Âl (as insia'llsd) Cafl for f nspection (24 hours notÍce) Before Covering Installaiion Adeq uaie compl ia nce v.;íih County i: ncJ State regu laiions/requirements Systern lnstaller_ Scotic lank Canaci',v Septic'lank lv'lanufecturer or liade Name Scotic Tank Access l¿ithir¡ 6" oi sulf¿ce Absoroiion Area Absorption Area Type andlar ManuÍacturer or J'rade Name *,------,, lnspeciorDate RETAIN f/ITH RECEIPT RECORDSAT CONSTRUCTION SITE CONDITIONS: 1. Allinstallation mustcomplyr¡¡ith allrequíremenisof the ColoradoState Board c,f Heafth lndividualselvage Disposalsystems Chapter 25, Arlicle 10 C.R.S. 1973, Revised 1984. 2. This permit is valÍd only for connection to structures which have fully compfied with County zoning and i buîlding requirements. Connection to or use wíth any dwetling or structures not approved by the Building and: Zoning ofÍice shall automatically be a violaiion or a requirement oí the permit and cause for boih legaf aciíond and revocation of the permiti 3. Any person who constructs, alters, or insialls an individualsewage disposal sysiem in a mannerwhich involves a l<nowing and maierial variaiion lrorn the terms or specifications contained in the application of permii commits a Class 1, Peäy Ofíense ($500.00 fine - 6 months in jaíl or both). Whiie - APPLICANT Yellow - DÊPART¡/ENT ffarfreld County ONSITË WASTEWATER TREATMENT SYSTEM (owrs) PERMIT APPLICATION Community Development Department'r 108 8th S$eet, su¡te 401 |'tÀY 0 I ?û11 Glenwood Springs, CO 81601 (97O| $a5-g¿12; www,sarfisld-county"ço-ilq TYPE OF COltSrRUCnOll K New lnstallatian WASTETYPE ElOther Describe 'El Alteration i_H r Use E Comm./lndustrial tr Non-Domestic Type of OWTS Pcrænl Gruund SlopcGmundConditions I]IVOLVED PAßNES PropertyOwner: Mailing Address: ;,lN Phone: MailingAddress: vzt Contractor:Phone: ( {'7p t Engineer:Phone: f ì PROIECT NAME AilD LOCANON lob Address: As¡essor's Parcel Number t2 MailingAddress: Buitdingorserviceryn", s$r-iE.tJd^e fJ li Garbage ci¡rnærÅl!/t [ât Bloek #tedroom¡r Distance to Nearest Community Sewer System;/1?'*,,Yirl*- was an effort made to connect to the Community Sewer System: Dclnlìto Groond *atcrt¡blc Final Disposal by El Abcorptlon trcndt. tod or Flt El Undrrgrcund Dtspcrrrl E Abovr Gror¡nd Disprmrl E Evrpotranspiration Wrstcwater Pond f- lT s.ni Fllter i Othcr water Sourc¡ &Typc çtscm Ëffluent E Ycs No CERTIFICATION Apolicant acknowledges that the completeness of the applicatíon is condltiona! f pgn such further ;riJ;¡;îå*;;l;äãniñitesian¿ reiorts as may be required by the local health de.partment to be il;;;;å'f;iititirãä uV tt "ãþpli.ànt br by the local he.alùh depaitment for pu.rposed of the evaluation "iitre äoolication; and t-fiãlli.ianie of thd permit is subject to such lerms and conditions as deemed äär;[1ii; inlí* .o*ó¡iani" wit¡t rules ánd regulatio-ns made, information and.reports submitted |iãi"ö¡i¡'uiïËã;ìreãlå Ue iu¡m¡tte¿ by the applicant are or will be represented to be true and correct to the belt of my knowledge and belief and are designed to be relied on by the.local d;;;;rr;;lãf f'uãtit1 in'evaluatinã the same for purposes oi issuing the. perm¡t apnlie.d for herein' I turttrer understand that any falsifièation or misrepresentation may result in the denial ot the åîdii*ti"f ór revocat¡on ıi añi peim¡t granted based upon said application and legal action for perjury as provided by law. I hereby acknowledge that ! have read and understand the Notice and Cenification above, as we¡l as, have provided the required information which is correct and accurate to the best of my knowledge. 4 r//",n Å, Property and Sign Date ?Þ.Wï.ût Cq ç w OFFICIAT USE ONIY Special Condítions: Fees Pald: 7T7.ooî-77.oo Totãl FeesiPerk Fee: lso.oo Permlt F€ê: l1'?.u> Balanceo"", ú lssue Date:l+Building Permit tTtpÆ. Seotic Permlt: Çf,vr -4?a8v BUIIDING/ PlÁNNING DlVlSlONr Date