HomeMy WebLinkAboutApplicationGarfield County —I
Community Development Department
RECEIVED 108 8"' Street, Suite 401
Glenwood Springs, CO 81601
OC T 2 3 2019 (970) 945-8212
GARFIELD COUNTY .earfield-county.com
COMMUNITY DE VELOPMBT
TYPE OF CONSTRUCTION
® New Installation
WASTE TYPE
I Dwelling
0 Other Describe
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
—1 D Alteration
O Repair
0 Transient Use — 0 Comm./Industrial T 0 Non -Domestic
INVOLVED PARTIES
Property Owner: CMH Horner inc Phone: ( 970 ) 245-9039
Mailing Address: 671 23 Road Grand Junction, CO 81505
Email Address: @claytonhomes.com
Contractor: Clayton Homes
Halling Address: 671 23 Road Grand Junction, CO 81505
Small Address: @claytonhomes.com
Phone: ( ) 970-245-9039
Engineer: Ken BrotskY phi; ( ) 970216-8861
Mailing Address:
Email Address: kbrotsky@yahoo.corn
PROJECT NAME AND LOCATION
Job Address: TBC Countylknad-237 Silt, CO 81652
Assessor's Parcel Number: 127363000073 Sub. Lot 24 Block 6
Building or Service Type: Single Family Residence #Bedrooms: 3 Garbage DIsposal(Y/N) No
Distance to Nearest Community Sewer System: 1 mile plus
Was an effort made to connect to the Community Sewer System: Yes
Type of OWTS
ES Septic Tank 1 0 Asratlon'Plent O Vault
O Recycling, Potable Use i 0 Recycling 0 Pit Privy 0 Incineration Toilet
0 Vault Privy 1 D Composting Toilet
O Chemical Toilet
0 Other
Ground Conditions
Final Disposal by
Water Source & Type
Effluent
Depth to VV Ground water table_ 9 1 Percent Ground Slope
11%
• Absorption trench, Red or Pit 0 Underground Dispersal 0 Above Ground Dispersal
O Evapotranspiration 1 0 Wastewater Pond O Sand Filter
0 Other
O Well 0 Spring 1 0 Stream orCreek 1 0 Cistern
O Community Water System Name
Will Effluent be discharged directly Into waters of the State? 0 Yes ra 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 I have read and understand the Notice and Certification above as well as
have provi s . he regrfli•ed information which is correct and accurate to the best of my knowledge.
Pr
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perty Owner Print and Sign
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fee:
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Tot I Fees:
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Fee aid
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Building Permit
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Septic Permit:
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Issue Date
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Balance Due:
476
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BUILDING/ PLANNING DIVISION:
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Signed Approval
1
Date