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HomeMy WebLinkAboutApplicationGarfield County Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.gar€leld-countv.com ./. ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE OF CONSTRUCTION © New Installation 1 CI Alteration • Repair WASTE TYPE ❑ Dwelling I • Transient Use i I] Comm./Industrial ■ Non -Domestic ■ Other Describe INVOLVED PARTIES Property Owner: Rudd LLC Malting Address: 132 Park Ave., Basalt, CO 61621 Phone: (970 ) 309-0123 cell Email Address: chris@ruddconstniction.com Contractor: Rudd Construction Mailing Address: 132 Park Ave., Basalt, CO 81621 Phone: (970 309-0123 cell Email Address: chris(cruddconstruction.com Engineer: Zancanella and Associates, Inc. Mailing Address: P.O. Box 1908, Glenwood Springs, CO 61602 Phone: (970 ) 945-5700 Email Address: tbeck@za-engineering.com PROJECT NAME AND LOCATION Job Address: 0062 County Road 113, Bldg. V, Carbondale, CO 81623 Assessor's Parcel Number: 239318100359 Sub. Lot Block Building or Service Type: Commercial Warehouse Distance to Nearest Community Sewer System: Unknown #Bedrooms: Garbage Disposal(Y/N) Was an effort made to connect to the Community Sewer System: No Type of OWTS p Septic Tank 0 Aeration Plant 0 Vault 0 Vault Privy E Composting Toilet ❑ Recycling, Potable Use 0 Recycling 0 Pit Privy 0 Incineration Toilet O Chemical Toilet ! 0 Other Ground Conditions Depth to 1't Ground water table 140 feel Percent Ground Slope Final Disposal by O Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal O Evapotranspiration 0 Wastewater Pond I Sand Filter ❑ Other Water Source & Type 0 Well 0 Spring ❑ Stream or Creek 0 Cistern ❑ Community Water System Name Effluent Will Effluent be discharged directly into waters of the State? 0 Yes III 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 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. Wayne Rudd Property Owner Print and Sign 07-25-19 Date OFFICIAL USE ONLY `Cl -/2n/i 9 re_ `257.x-- as Special Conditions: Permit Fee: C10 Perk Fee: +r.. Fees: TotalT7�? Y':.00+ Fees Paid: CO Building Permit am- 1-1 Septic Permit:-l SE Issue Date: 10/28/2020 Balace Due: . CO V (cr ti ea 16 BF1ki:1��fNING PIRSI h f�/ �� / iN: /fi-'%� -` / G!% may lF 6 _ l g �// Z/ C47 Signed Approval Date