HomeMy WebLinkAboutApplicationRECEIVED GARFIELD G0JN' comMUNITY DEVELJPW 195 W. 10' Street Rifle, CO 81650 (970) 625-5200 Gar -eld County �T Public Health 2014 Blake Avenue Glenwood Springs, CO 81601 (970) 945-6614 ANTS PERMIT APPLICATION TYPE OF SYSTEM CONSTRUCTION ® New Installation BUILDING USAGE TYPE B Dwelling_ 1 ❑ Transient Use ❑ Other Describe ❑ Alteration ❑ Repair ❑ Comm./Industrial :TO Non -Domestic INVOLVED PARTIES Property owner: deyon & Craig Spaulding — — Phone: 970 309.1267 Mailing Address:1a441 CR 311, sih, Co 81652 Email Address: cspauldinglg@gmail.com; dspaulding@mounlaintamlly.org Contractor: owner constructed Phone: (970 ) 309-1267 Malting Address: same Email Address: same Engineer: sopris Engineering, Paul Rutledge & Yancy Nichol Phone 0311 Mailing Address: 502 Main Street, Suite A3, Carbondale, CO 81623 I. I Email Address: prusedge@sopriseng.com PROJECT LOCATION AND DESCRIPTION Job Address: 10441 CR 311. Silt, CO B1652 Assessor's Parcel Number-24012420027s Sub Record Ranch SuhdivlsianFxemplicn Lottotz. Block Building or Service Type:Residentlai #Bedrooms:3 Garbage Disposal(Y/N)no Distance to Nearest Community Sewer System: , 5 mile Was an effort made to connect to the Community Sewer System: NIA Potable Water Source IN Well ❑ spring ❑Stream or Creek ❑ Cistern & Type ElCommunity 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. _ �Iz Proper Owner Print and Sign Date OFFICIAL USE ONLY 4' I23,60-6 Mt kt oG oi� mtAoZ1 special Conditions: Permit Fee: Total Fees: Fees Paid: 02. Building Permit iiIRRLr- `8-es OWTS Permit: seQr • ('%9 Issue Date: Balance Due: Garfield County Public Health Department: G f a,{ Signed Approval Date