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195 W. 14th Street Rifle, CO 81650 (970) 625-5200 2014 Blake Avenue Glenwood Springs, CO 81601 (970) 945-6614 OWTS PERMIT APPLICATION TYPE OF SYSTEM CONSTRUCTION ❑ New Installation I Alteration BUILDING USAGE TYPE IA Dwelling I ❑ Transient Use 0 Comm./Industrial 0 Repair ❑ Non -Domestic 0 Other Describe INVOLVED PARTIES Property Owner 54,x/- "Lick sea. Phone:1970 ) kg -39 S9 Mailing Address: CMOS- s. OG..k Lucky' G4entm ock Cr;„ / CO &1t,G4 Email Address: SCott fO rx¢Isor�S tti-o bcicty., cow. Contractor:1)(n Co/Ns fry a;o✓s Phonei:jR70 1S -7S -0'a- Mailing Address: 'S10 til ' S.,' • Gk." wdoo& Set , Co $11,0 4 Email Address: jMr X2 c.(w, rv¢c..lntiv.. cow. Engineer C43c, S¢n��c G-r�rlc�. ©SAaoD Phone: TT -701 301-S SG] Mailing Address: 33 /Coo r-tk%'n( `a)rive lot Cari.va,nv(nok Co Ric- s Email Address: Gat- , os/ -6r3 0 atv.r„it. rr0w•-- PROJECT LOCATION AND DESCRIPTION Job Address: 030 5". C"iwlC W Cotein.s0071r3torg ,nas, £O to0` Assessor's Parcel Number:a395aatO \OOo\ Sub -Goat A c.. -t0 wS Lot1:71%Block Building or Service Type: 5/ nate Fct icy #Bedrooms: 3 Garbage Disposal(ht) ti Distance to Nearest Community Sewer System: ,4/4 Was an effort made to connect to the Community Sewer System: Potable Water Source 14. Well © spring ❑ Stream or creek & Type 0 Community Water System Name 0 Cistern Garfield County Public Health Department —working to promote health and prevent disease (11111( 1f A n fitif 11111.1.. „.„ 114 1.11.11�r1.•rlrf a 0, 14, .30. r j44 41rwI••4 41 ./ "'*.. !k'4111I Nvq. r •r41r1144•14 .r1 114•11 to-fo ►trr•rgW 11,.•'ousiwl polo i1.4H1,1'.'h 1►s r1 4444 .11-te.••r ►•' .4.44.4 ••. •.•SI 4.4, Noy •f1.1 I4- It 11,. 'no, fr•1 e,r►•le 4lrer •tr •fill n,•6•1.- „.a• 111, na. I,nr' Ili 1rµ I, ,rIII' „•1• •r' q •�.. t•.' it 'V urn f••1hp'nr.. 11 11•r .p.r'f.'•.• er rrq �!-r•Nr ..M r.fn Ih. nf•fd1' 11111•U Wel 11.► 114,•;i4 44, .4' •.q =p.. P..r h 41 r.,..•1 ' i.i!I ^/.'ret lrrf •044/14444,rf♦ 1 Irrr+.o., 44// ••: •.pry I! Ir.ri1,/ r jri,a'1• • rot.% . Iv-. poi. '01' 1 Ir.•r•r 9.4.14.• 411'••4 u'.vf lrrf-•rylr+r►4 ...Ferr. rr+r t hr•.nM•111 'OW 44 ,4i41.4.41 Ir Ir 4.�p• P' 1 .• .V .•.r 1.•4'411' *or N•+ •l 4411 ..,. wrr•.Yrarr.l 411 ,r 'f', # M1.1 4 n'•F4e 11 Til ti -C -c 1 rrr '44,. 1'•.•.r.J U..j1N A'.•''.' I. � we. MY 1410.4.q..W* "1• Hd'V11.11t 4r 44V 4140 1 'r 1.1 ,14•Irlf,lnlr•r1, of r,r•fih► it 4•144. u'i•r[ •s.. 1•r r. •r r 14,44,1 •fr.. !.•r'H4 !4•!411,..1 h.r +14.944,111 1 1e1.1hb. 4140414•re 1114141 1404, gr.l: I '44.1111• :eV,. r'M ••, •c.•„;.•I cI••r;1h14• '01st Il rhp 1,.,.4:1I 1i •hM plrl loo '.41'14• tie ,,..,.r ;4'/414. 114'1f11 po..r..f. t-irr!'!ai SkSf+Y LFse Iceiti•Jr4on end.rnpl1 i ?VIII Mf” I/�►►ll!/•I p'. 1i'flv.rh'0 Uy If"W I barony Isf knr.wkedep that I hvvp rPAv ap•1.1 eJ*i?[-S*lr'd ti'!e'Cyte kmd CN!ff c)t *two. Y. wrl i?' hav►• prnwdr•d *fit rre:A/w d mice+r.srcen-ect lr•d i[•t-w-pt'ty the ttr+t u/ rr.y IkrInvAr•drlb. y+ f' _. S1 _ � _4 y •� r r'rvlperry Owner Print ■nd n L,1 Data OFFICIAL USA ONO' 1914.:►.( Lundrthwis hrnlrr roe $75.00 t vial Owes 4.44 ft" -$75.00 $75.00 M•+erdl.W lr.rrlrl awry erre* .1r1 it MAW BLRE-02-21-6683 SEPT -02-21-6684 Z4Oc/ brebehl Calmly Pu.il. •W4*tf Fle1ra.•nwei - aipernmar buluwif (belt. $0.00 PD. $75.00, CC, 2/9/2021 el¢ 1 1