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HomeMy WebLinkAboutApplication195 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 Property Owner: Aspen Polo Partners LLP Phone: ( 561 ) 310-3336 Mailing Address: 101 S. Mill Street, Suite 200 Aspen, CO 81611 • New Installation L E Alteration • Repair BUILDING USAGE TYPE Email Address: max@dividecreekbuilders.com ❑ Dwelling ❑ Transient Use [ RI Comm./Industrial Mailing Address: 592 Highway 133 Carbondale, CO 81623 ❑ Non -Domestic • Other Describe Agricultural barn with groom's guarters PROJECT LOCATION AND DESCRIPTION Job Address: 16411 Hwy 82 Carbondale, CO 81623 (aka 27 Chukka Trail) Assessor's Parcel Number: Building or Service Type: Distance to Nearest Community Was an effort made to connect 239131100033 Sub. m/b (TCI Ranch Lot 5 Block n/a AgnculturaI bam with grooms quarters #Bedrooms: 4 Garbage Disposal(Y/N) N INVOLVED PARTIES Property Owner: Aspen Polo Partners LLP Phone: ( 561 ) 310-3336 Mailing Address: 101 S. Mill Street, Suite 200 Aspen, CO 81611 Email Address: mganzi@digitalcolony.com Contractor: Divide Creek Builders, Inc. Phone: ( 970 ) 963.3555 Mailing Address: 75 N 2nd Street, Suite B Carbondale, CO 81623 Email Address: max@dividecreekbuilders.com Engineer: Roaring Fork Engineering Phone: { can 1 340-4130 Mailing Address: 592 Highway 133 Carbondale, CO 81623 Email Address: vincentt@rteng.biz PROJECT LOCATION AND DESCRIPTION Job Address: 16411 Hwy 82 Carbondale, CO 81623 (aka 27 Chukka Trail) Assessor's Parcel Number: Building or Service Type: Distance to Nearest Community Was an effort made to connect 239131100033 Sub. m/b (TCI Ranch Lot 5 Block n/a AgnculturaI bam with grooms quarters #Bedrooms: 4 Garbage Disposal(Y/N) N Sewer to the System: 1.75 miles Community Sewer System: res e'tnaFteee'bie-o4VTS Per Ce"ePee"el,Reeelutian2G16-1° Potable Water Source & Type 0 Well ❑ 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 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. Property Owner Print and Sign 10-26-20 Date OFFICIAL USE ONLY Special Conditions: Permit Fee: $75.00 Total Fees: $75.00 Fees Paid: $75.00 Building Permit BLRE-10-20-6552 OWTS Permit: SEPT -10-20-6553 f Issue Date: 01/13/2021 Balance Due: $0.00 Garfield County Public Health Department: 0 �1 Ott /t"��— ( ^+! 0 Sighed Approval Date PD. $75.00, CC, 1D/26/2020 Page 5 of 3 Updalcd Dee 2013