HomeMy WebLinkAboutApplication195 W. 14th Street
Rifle, CO 81650
(970) 625-5200
CGarfield County
Public Health
2014 Blake Avenue
Glenwood Springs, CO 81601
(970) 945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
❑ New Installation ® Alteration
BUILDING USAGE TYPE
❑ Repair
03 Dwelling ❑ Transient Use I ❑ Comm ,/Industrial 0 Non -Domestic
0 Other Describe
INVOLVED PARTIES
Property Owner: Richard Nash
Phone: ( 970 ) 379-5172
Mailing Address: 0965 Westbank Rd. Glenwood Springs CO, 81601
Email Address: Richard@nashconstructioncompany.com
970-
Contractor: Owner Phone:
79-5172
Mailing Address: 0965 Westbank Rd. Glenwood Springs CO, 81601
Email Address: Richar c,'nashconstructioncompany.com
Engineer: n/a
Mailing Address:
Email Address:
Phone: (
PROJECT LOCATION AND DESCRIPTION
Job Address: 0965 Westbank Rd. Glenwood Springs CO, 81601
Assessor's Parcel Number: 218535301015 Sub. Westbank Lot 1 Block
Building or Service Type: Garage #Bedrooms: n/a Garbage Disposal(YJN) n
Distance to Nearest Community Sewer System: None available
Was an effort made to connect to the Community Sewer System: n/a
Potable Water Source 0 Well ❑ Spring ❑ Stream or Creek 0 Cistern
& Type a Community water System Name Westbank ater -district
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 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 provided the required information which is correct and accurate to the best of
my knowledge.
iptelly signed try Richard A. Nash
O CWS. E=+erwu7jriUsrasrrash.00m. O=Nash
Richard A. Nash .vas Nw�.o�-NaahCans, on Carnpary.
WM. 2029 DB 213 09:01:n06W
Property Owner Print and Sign
8-28-2020
Date
OFFICIAL USE ONLY
Special Conditions:
Per tFee:
1.5. OD
Total Fees
��5. oo
Fees Paid:
K. 00
Building
131,
Permit
- (DO5
owTS Permit:
• (oi
Issue Date:
9/29/2020
Balance Due:
Garfield County Public Health Department:
/
De, Cr.------ J5JOO
_
Signed ppro
al Date
45.00, c.c,'b