HomeMy WebLinkAboutApplicationRECEIVED
GARFIELD COUNTY
COMMUNITY flE'tP'i OPMENT
195 W. 14th Street
Rifle, CO 81650
(970) 625-5200
Garfield County
Public Health
2014 Blake Avenue
Glenwood Springs, CO 81601
(970) 945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
lX New Installation
❑ Alteration
1
0 Repair
BUILDING USAGE TYPE
® Dwelling 0 Transient Use
0 Comm./Industrial
1 0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner: Strait Bottom Ranch LLP
Mailing Address: Po Box 26. Woody Creek. C081656
Email Address:
Phone:1
Contractor: TEP Rocky Mountain LLC
Mailing Address: PO Box 370. Parachute. co 91635
Email Address: BHolardigterraep.corninicintosh@terraep.com
Phone: ( 970 ) 285.9377
Engineer: Fox Engineering Solutions. Inc.
Mailing Address: 670 Canyon Creek Drive. Grand Junction. Co 81507
Email Address: coloradofox@bresnan.net
Phone: ( 970 }
250-6505
PROJECT LOCATION AND DESCRIPTION
Job Address: SG 23-22 Pad
Assessor's Parcel Number: 240922300118 Sub. tot Block
Building or Service Type: Small Temp Employee Housing
Distance to Nearest Community Sewer System; NA
Was an effort made to connect to the Community Sewer System: NA
((Bedrooms: 7 Garbage Disposar(Y/N) N
Potable Water Source
& Type
17 Well I D Spring 0 Stream or Creek
0 Community Water System Name City of Rine
0 Cistern
Garfield County Public Health Department — working to promote health and prevent disease
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additional tests 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 purpose of the evaluation of
the application; and the issuance of the permit is subject to such ter ins dial t:unditiuns 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.
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 provided the required information which is correct and accurate to the best of
my k owledge.
Property Ow -r Print and Sign
to
OFFICIAL USE ONLY
Special Conditions:
Fee:
Total Fees:
Fees Paid:
qcPermit
Building Permit
CCOWrTS Permit:
5Ep- (9133-
Issue Date:
03/09/2020
Balance Due: f�
Garfield CountyPublic Health
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Department:�� _03a0aeolc��'
Signed Approval Date
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?D. * IS, 00, CC/ 2 1.4.7.07-4, 7.07.a