HomeMy WebLinkAboutApplication195 W.14t' Street
Rifle, CO 81650
(970)625-5200
Garfield County
Public Health 2014 Blake Avenue
Glenwood Springs, CO 81601
(970) 945-6614
4WVTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
® New Installation ❑ Alteration ! ❑ Repair
BUILDING USAGE TYPE
® Dwelling ❑ Transient Use I ❑ Comm./Industrial ❑ Non -Domestic
❑ Other Describe
INVOLVED PARTIES
Pro e . rty Owner: David Ro
wley Phone:( 917 ) 658-9122
-_,
Mailing Address:8310 Banpo Bridge Way, Delray Beach, FL 3 3446-00 30
Email Address: dsrowley@gmail.com
Contractor: RM Construction Phone:( 970 ) 300-2025
Mailing Address: 5030 Cc Rd, 154 Glenwood Springs, CO 81601
Email Address: biake@buildwithrm.com
Engineer: Keith Mendenhall, Dean Goebel Phone.( 970 1261-9952 (970)241-7076
Mailing Address: 2764 Compass Dr, 9230 Grand Junction, CO 81506
Email Address: keithm@summitae.com drg@westwaterco.com
PROJECT LOCATION AND DESCRIPTION
Job Address: 1121 Callicotte Ranch Rd. Carbondale, CO
Assessor's Parcel Number:239324206025 Suh.Callicotte Ranch Sub. Lot25 Block
Building or Service Type: Residential #Bedrooms:4 Garbage Disposal(Y/N)Yes
Distance to Nearest Community SewerSystem: NIA, ail homes have individual septic systems
Was an effort made to connect to the Community Sewer System: NIA
Potable Water Source ❑ Well ❑ Spring ❑ stream or [reek C] Cistern
&Type N Community Water5ystemName Callicotte Ranch HOA Water System
Garfield County Public Health Department —working to promote health and prevent disease
CER'�IFfEAYION � - t _
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 heaith 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 Owner Print and Sign
7/23/20;Zl
Date
OFFICIAL USE ONLY
IRd CC °7s/'W/20
Special Conditions:
Permit Fee:
4123,110
Total Fees:
* I'L3."'�'
Fees Paid:
t 123-tso
Building Permit
OWTS Permit:
Issue Date:
Balance Due:
GLF—E-G99a,
s6PT- (69VI
lcdl z�'�l
Garfield County Public Health ❑e artmenV
Signed Approval
Date