HomeMy WebLinkAboutApplicationGaffield County
1"95 w. 14th Street
Rifle, CO 81650
(970) 62s-s200
Public Health
OWTS PERMITAPPLICATI ON
SYSTEM CONSTRUCTION
lnstallation n Alteration '-I U Repair
BUILDING USAGE TYPE
tr Non-Domestic
20L4 Blake Avenue
Glenwood Springs, CO 8L60L
(970) 94s-6614
n Dwelling n-rrJniient Use i n comm./in¿ustrialI
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E Other Describe
II.¡\'OLVED PARTIES
Property
MailingAdd
Email Address:
MailingAddress:
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Mailing Address:
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PROJECT LOCATION DESCRIPTION
Job Address:
Assessor's Parcel Num Lot Block _
Building or serv¡ce rype: t€þi 倡¡a{i a,\ *eedrooms: 5 Garbage Disposat(y/N Ll_
D¡stance to Nearest Community SewerSystem:
Was an effort made to connect to the Community Sewer System:
Well E Stream or Creek E cistern
n CommunityWatersystem Name
[1 SpringPotable Water Source
&Type
Garfield County Public Health Department - working to promote health and prevent disease
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PropertY owner Print and Sign
Date
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OFFICIAL USE ONIY fiÀ,
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I t ee.9r Balance Due:
.splssue Datê:
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Garfleld County Public Heðlth Departmenti
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Date
Approval