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HomeMy WebLinkAboutApplicationGarfield County RECE{VED Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfietd-countv.com NI)V n19 GP RA Y 0EC OUSre GO0 MEM �AMU TYPE OF CONSTRUCTION ® New Installation WASTE TYPE • Dwelling ! 0 Transient Use 0 Other Describe ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION I D Alteration 0 Repair IC Comm./Industrial 1 D Non -Domestic INVOLVED PARTIES Property Owner: Keila Valenzuela Phone: ( 970 ) 456-683 Mailing Address: 1853 Colorado Road Glenwood Springs, CO 81601 Email Address: Contractor: CI-yton Homes Phone: ( ) 970-245-9039 Mailing Address: 671 23 Road Grand Junction, CO 81505 Small Address: ©claytonhomes.com Engineer: 4- I<en Brdtsky Mailing Address: Email Address: kbrotsky@yahoo.com Phone: ( 91D 216-8861 PROJECT NAME AND LOCATION Job Address; TBD County Road 154 Glenwood Springs, CO 81301 Assessor's Parcel Number: 218536300015 Sub. Lot 3 Block Building or Service Type: Manufactured *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 — Ground Conditions final Disposal by Water Source & Type Effluent Septic Tank 0 Aeration- Plant 1 113 Vault D Vault Privy J El Composting Toilet D Recycling, Potable Use 1 CI Recycling CI Pit Privy # 0 Incineration Toilet D Chemical Toilet 13 Other Depth to Ground water table 1 Percent Ground Slope I Absorption trench, Bed or Pit 1 D Underground Dispersal t © Above Ground Dispersal Cl Evapotranspiration 1 0 Wastewater Pond 7 Sand Filter O Other ® Well i 0 Spring 0 Stream or Creek 1 0 Cistern t7 Community Water System Name Wil[ Effluent be discharged directly Into waters of the State? 0 Yes CI No CER 1FICATiON 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. 1 fapplication union or rand that evocation of any granted based upon or n said application atioresult Inn and legalhe ) of the action for perjury application or r Y p as provided by law. I hereby acknowledge that I have read and understand the Notice and Certification above as well as have pro I • ed th required information which s correct and accurate to theof I knowledge. 7 Date OFFICIAL USE ONLY penial Candltions: Permit Fee; Building Permit 0 Park Fee: Total Feel: 2: BUILDING/ PLANNING DIVISION: f -7,V V-)2- OCA GASH,