HomeMy WebLinkAboutApplicationEe Garfield County
195 W. 141n Street Public Health 2014 Blake Avenue
Rifle, CO 81650 Glenwood Springs, CO 81601
(970)625-5200 (970)945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
❑ New Installation
BUILDING USAGE TYPE
❑ Dwelling ❑ Transient Use
[]Other Describe
INVOLVED PARTIES
i ® Alteration
® Comm./Industrial
j ❑ Repair
❑ Nan -Domestic
Property Owner: CCc-a t_Lt_P Phone: ( 970 ) 309-0123
Mailing Address: 132 Park Ave, Basalt, CO 81621
Email Address: Chris@ruddconstruction.com
Contractor: Rudd Construction, Inc. Phone: ( 970 309-0123
Mailing Address: 132 Park Ave, Basalt, CO 81621
Email Address: chriS@ruddConstruction.com
Engineer: Zancanella & Associates. Inc. Phone.( 97o ] 945-1253
Mailing Address; P.O. Box 1904, 1005 Cooper Ave, Glenwood Springs, CO 81602
I
1 Email Address: tbeck@za-engineering-com
PROJECT LOCATION AND DESCRIPTIpN
JobAddress: 0062 County Road 113 Hldg 8, Carbondale, Co 81823
Assessor's Parcel Number: 2393-181-00-358 Sub. Lot Block
Building or Service Type: Commercial #Bedrooms: Garbage Disposal(Y/N)
Distance to Nearest Community Sewer System: N/A
Was an effort made to connect to the Community Sewer System: N/A
Potable Water Source
& Type
Well ❑ Sprfng ❑Stream ar Creek
❑ Community Water System Name
❑ Cistern
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.
Wayne Rudd (.t1 `rp i 3-26-2021
Property Owner Print and Sign Date
OFFICIAL USE ONLY
spedal Conditions:
Permit Fee:
4 7r. va
Total Fees:
#'tS, Oe
Fees Paid:
$ IG, ec
Building Permit
13LCO - 4T$3
oWTS Permit:
SEPT- 6194
Issue Date:
z'i
ZC) zI
Balance Due:
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Garfield County Public Health Department:
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Signed Approval
Date
Pagoe 5 of t
Updated Dee 201 {