HomeMy WebLinkAboutOWTS Design Report 04.23.2020• 108 Eighth Street, Suite 4U1
Glenwood Springs, Colorado 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
pROPERTY
Owner's Name
System Location
Permit
Assessor's Parcel No.
This does not constitute
a building or use permit.
Present Address 1013 C // Z
Phoriet;Ve- ///
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon)
Percolation Rate (minutes/inch)
Required Absorption Area - See Attached
/A/ ZiegAle-A7
74- .s --e. iJ Fier �-1s.
Inspector_ � Q1---_ '2A7
Other
Number of Bedrooms (or other)
Special Setback Requirements:
Date
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type andlor Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other.
D ate
Inspector
- —
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
1A
CONDITIONS:inst
1I Ail a ust comply with all requirements of the Colorado State Board of Health Individual Sewage
Disposal Systems Chapter 25, Article 10 G.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have fully complied with County zoning and
building requirements. Connection to or use with any dwelling or structures not approved by the Building and
Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal action
and revocation of the permit.
3. Any peen who constructs, alters, or installs an individual sewage disposal system in a manner which
involves a knowing and material variation from the terms or specifications contained in the application of
permit commits -a Class 1, Petty Offense ($500.00 fine - 6 months in jail or both).
White -APPLICANT Yellow - DEPARTMENT
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