HomeMy WebLinkAboutApplication195 W. 14'h 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
❑ New Installation I IR Alteration I ❑ Repair
BUILDING USAGE TYPE
0 Dwelling II 0 Transient Use I 0 Comrn./industrial I 0 Non -Domestic
8 Other Describe tie•in Ag exempt ha!f bath in new bam to existing septic system for house, No additional living space
INVOLVED PARTIES
Property Owner: Susan Bachman Phone: (901 ) 359-5859
Mailing Address: 551 Elk Valley Ln , New Castle, CO 61647
Email Address:
Contractor: Morton Buildings, Inc. Phone: (970 ) 531-0785
Mailing Address: 425 Kristen Ct-, Montrose. C081401
Email Address: maurice.sharp@mortonbuildings,com
Engineer: Phone: (
Mailing Address:
Email Address:
PROJECT LOCATION AND DESCRIPTION
Job Address: 551 Elk Valley Ln„ Now Castle, CO 81647
Assessor's Parcel Number: 212306300136
Sub, lob arungs Exemption
Lot Parcel eA Block
Building or Service Type: ug. bldg. -hall bath #Bedrooms: Garbage Disposal(Y/N)
Distance to Nearest Community Sewer System: NrA
Was an effort made to connect to the Community Sewer System: N/A
Potable Water Source j B Well
& Type
0 Spring ❑ Stream or Creek
❑ Cistern
❑ Community Water System Name
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 an 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.
1 hereby acknowledge that 1 have read and understand the Notice and Certification a'oeve 25 well as
have provided the required information which is correct and accurate to the best of my knowledge,
Property Owner Print and Sign
i_$ek Cinn'')CL") Ati � Li r , X)10
Da t:1
OFFICIAL USE ONLY
Special Conditions:
., r- cx c iuA 5q h c. -' (k 1;ok , iAct ccu-e dt A.A Sys4e %T.ASc) C:R.tvl c e.e r f
Permit Fee:
$75.00
Total Fees:
$75.00
Fees Pald:
$75.00
Building Permit
N/A
OWTS Permit:
SEPT-08-20-6454
Issue Date: 10/20/2020
Balance Due:
$0.00
Garfield County Public Health
r�
Department: Io/a OI C
Signed pproval Date
P0. $75.00, CC, 8/25/2020