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HomeMy WebLinkAboutApplicationGarfield County Community Development Department RECEIVE 81h Street, Suite401 Glenwood Springs, CO 81601 OCT 2 8 (970) 945-8212 Mir i-cou ntv.com GARFIELD C e WIMIJNITY DEVELOPMENT TYPE OF CONSTRUCTION la New Installation WASTE TYPE ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION O Alteration 0 Repair D Dwelling 0 Transient Use D Comm./Industrial 1 0 Non -Domestic 0 Other Describe INVOLVED PARTIES Property Owner: CMH Homes inc , Phone: ( 970 ) 245-9039 Mailing Address: 671 23 Road Grand Junction, CO 81505 Email Address: @claytonhomes.com Contractor: Clayton Homes Mailing Address: 671 23 Road Grand Junction, CO 81505 Email Address: @ciaytonhomes.com Engineer: Ken Brotsky Mailing Address: Email Address: kbrotsky@yahoo.com Phone:1 $70-245-9039. Phone: ) 970-216-8861 PROJECT NAME AND LOCATION Job Address: T U C unty tEZ 237 -Silt, C0. 8 -1-6Y Assessor's Parcel Number: 2127363000074 Sub. _ Lot _1()_ Block 6 Building or Service Type: Single Fatuity Residence *Bedrooms: 4 Garbage Dlsposal(Y/N) No Distance to Nearest Community Sewer System: 1 mile plug Was an effort made to connect to the Community Sewer System: Yes Type of OWTS Ed Septiclank ! D Aeration Plenti 3 Vault j © Vault Privy I Composting Toilet D Recycling, Potable Use 1 0 Recycling fi 0 Pat Privy -i Incineration Toilet D Chemical Toilet ' 0 Other Ground Conditions Final Disposal by Water Source & Type Effluent Depth to 1" Ground water table 9' Percent Ground Slope 2% 1111 Absorption trench. Bed or Pit j 0 Underground Dispersal Evapotranspiration 0 Wastewater Pond 0 Sand Filter D Other 0 Above Ground Dispersal I8 Well 0 Spring f 0 Stream or Creek l 0 Cistern D Community Water System Name Will Effluent be discharged directly into waters of the State? 0 Yes 1111 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 Bald application and legal action for perjury as provided by law. 1 hereby acknowledge that I have read and understand the Notice and Certification above as well as have p the required information which Is correct and accurate to the best of my knowledge. Property Owner Print Date OFFICIAL USE ONLY Spedil DcndItIonsI of,8/rc 41/2e2. Permit Fee: reo — Building Permlt Perk Fee: thCa Septic Permit: ees Paid: BUILDING/ PLANNING DIVISION: Signed A Du�e� prowl