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