HomeMy WebLinkAboutApplicationRECEIVED
GARFIELD COUN
COMMUNITY DFVt=i n...
195 W. 14`" Street
Rifle, CO 81650
(970) 625-5200
�, Garfield County �
2014 Blake Avenue
Glenwood Springs, CO 81601
(970)945-6614
®HUTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION -
la New Installation _—...-._...._.1 ❑ Alteration- — —� -❑ Repair _
BUILDING USAGE TYPE - a
Cd Dwelling ❑ Transient Use ❑ Comm./industrial ❑ Non -Domestic
❑ Other Describe
jf iNVOIVEDPARTIES-
I—
I Property Owner., Edward Vandenberg and Marcia Morgan _ phone; 303 ) 601.86t37
Mailing Address: 3241 S.Ogdeu Street Englewood, CO 80113
I
Email Address: edward,vendenberg®comraeLnet
Contractor; Mountain Tpwn Builders, I_LC. Phone: ( 970 } 355-OB59
Mailing Address: PO Box 405 rNew Castle, CO 81647
Email Address: wes@mountaintownbuilders,corr,
Engineer: High Country Engineering, Inc. Phone: ( 970 1 945.8676
Mailing Address; 1517 Blake Avenue, STE 101
Email Address: t s hcen .com
PR0IECT LOCATION AND DESCRIPTION
Job Address: 284 sun King drive Glenwood Springs, CO 8t601
i
Assessor's Parcel Number: Rec 9466581 Sub. Irwin Subdivision EaampMn Lot 1 & 2 Black
Building or Service Type; 9F Herne #Bedrooms:i_Garbage Disposat(Y/N) r
Distance to Nearest Community SewerSystem: 10 miles
Was an effort made to connect to the Community Sewer System: no
Potable Water Source' 8 Well ❑ Spring ❑ Stream or Creek
& Type ❑ Community Water System Name
M Cistern
CERTIFICATIM
Applicant acknowledges that the completeness of the application is conditional upon such turtner
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 apolication• nnrt +F- ;ccl inn— f tk-
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.
Property Dwn rint and Sign Date
OFFICIAL USE ONLY al&�� oftrC �f3 ��xoz1 ` Jt
Special Conditions:
Por it Fee: co Total fees: Fees Paid: COD
Bullding Permit oWTS Permit: Issue Date: Belancq due:
Wim-
Garfieid CountY Public Health Department: "" � " C,
Signed Approval Date
AV