HomeMy WebLinkAboutApplicationcu Garfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
0 New Installation
WASTE TYPE
0 Dwelling _i 0 Transient Use
0 Other Describe
�5u1 LI � I
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
0 Alteration
0 Repair
0 Comm./Industrial
0 Non -Domestic
INVOLVED PARTIES
Property Owner: Christopher & Maria Anna Stallings
Mailing Address: 201 Vista Drive, Silt, CO 81652
Email Address: northmeadowdrive@gmail.com
Phone: P ) 618-4289
Contractor: Jay Billington
Mailing Address: 179 River Vista, GLenwood Springs, CO 81601
Email Address: JDBCon@yahoo.com
Phone: (aos ) 313-0699
Engineer: Garfield County
Mailing Address:
Email Address:
Phone: ( )
PROJECT NAME AND LOCATION
Job Address: Section: 5 Township: 6 Range: 92 Subdivision: SUN MEADOW ESTATES Lot: 5
Assessor's Parcel Number: 217905202005 Sub, Sun Meadow Estates
Building or Service Type: New Single Family Home
Lot 5 Block
#Bedrooms: 5 Garbage Disposal(Y/N) yes
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System: nra
Type of OWTS 0 Septic Tank 0 Aeration Plant 0 Vault
0 Vault Privy
O Recycling, Potable Use 0 Recycling 0 Pit Privy
O Composting Toilet
0 Incineration Toilet
O Chemical Toilet 0 Other
Ground Conditions
Depth to Ground water table
Final Disposal by
I Percent Ground Slope
❑ Absorption trench, Bed or Pit lg Underground Dispersal 0 Above Ground Dispersal
O Evapotranspiration ❑ Wastewater Pond ^ Sand Filter
❑ Other
Water Source & Type 0 Well 0 Spring 0 Stream or Creek 0 Cistern
Community Water System Name
Effluent Will Effluent be discharged directly into waters of the State? 0 Yes 0 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 1 have read and understand the Notice and Certification above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
dIAN )449
Property Owner Print and Sign
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
X23.00
Perk Fee:
1ST .rte
Total Fees:
2I3. ao
Fees Paid:
213 00
Building Permit
13 Litc- 52b3
Septic Permit:
WT. -5244f
Issue Dat :Balance
t I 1
Due:
BUILDING/ PLANNING DIVISION:
�i y vie
Signed Approval Date
pb. v-5.00 / 3t 41-, 52-5 lig