HomeMy WebLinkAboutApplicationRECENE
Garfield County
Community Development Department
E8 h 9(/19/ 108 8'h Street, Suite 401
GARFlEtO
COUNTY Glenwood Springs, CO 81601 (;0111M11N5Y DE VE►-aP ANT (970) 945-8212
www.garfield-countv.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
❑ New Installation 0 Alteration
WASTE TYPE
0 Repair
El Dwelling
0 Transient Use
0 Comm./Industrial
0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner:
Mailing Address:
Email Address:
Gregory S. Gaisford
1211 Hedtage Dr
Carbondale, CO 81623
Phone: (303 ) 919-6222
Contractor:
Mailing Address:
Email Address:
Phone:
En- gineer:
Mailing Address:
Email Address:
Phone:
PROJECT NAME AND LOCATION
Job Address: 888 Schooner Ln.
Carbondale, CO 81623
Assessor's Parcel Number: 239129305025 Sub. Stirling Ranch
Building or Service Type: dwelling/ art studio
Lot 25 Block
#Bedrooms: 4 Garbage Disposal(Y/N) yes
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Type of OWTS
NO
O Septic Tank 0 Aeration Plant I 0 Vault 0 Vault Privy [ Composting Toilet
L —
O Recycling, Potable Use 0 Recycling 0 Pit Privy 0 Incineration Toilet
O Chemical Toilet
0 Other
Ground Conditions
Depth to 1st Ground water table
Percent Ground Slope
Final Disposal by
O Absorption trench, Bed or Pit I 0 Underground Dispersal y ❑ Above Ground Dispersal
I !
O Evapotranspiration
I0 Wastewater Pond 0 Sand Filter
O Other
Water Source & Type
Effluent
O Well 0 Spring
0 Stream or Creek
0 Cistern
O l Community Water System Name stirling ranch
Will Effluent be discharged directly into waters of the State?
❑ 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
have pr
nowiedge that I have read and understand the Notice and Certification above as well as
the riequir : . infory�iation which is correct and accurate to the best • f my k u wledge.
Property Owner Print a; d Sign
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
-00
Perk Fee:
—
Total Fees:
.1 0
Fees Paid:
00
Building Permit_
" g4I
Septic Permit:
sem- 514-2
Issue Date:
4/n/19
Balance Due:
/16
BUILDING PLANNING DIVISION:
'3 ��1 `
Signed Approval
Date
pi 4 --Soo, Ccs z 2(v