HomeMy WebLinkAboutApplicationREGEIVL¡J
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GARFIËLÞ COUNTY
COMMUNITY DF.VELOPMENT
195 W. 14th Street
Rifle, CO B1650
(970) 62s-s200
Fublic Heøl,tk
OWTS PEIRMIT APP LICATION
TYPE OF SYSTTIM CONSTRUCTION
i8 New lnstallation tl Repair
20L4 Blake Avenue
Glenwood Springs, CO 81601
(970) e4s-6614
BUILDING USAGE WPE
n Alteration
n Comm,/lndustrial E Non-DomesticE Dwelling , I
Ü Other Describe
Transient Use
Gaffield County
INVOLVED PARTIES
Property Ji mmv Ter¡ri Phone ( 720 ) 428-0534
Mailing Add 5444 CR226 New 1 7
Email Address:jt@tebuilders.net
Contractor; l'E Builders * *.Phone: (.120-.)428-0!i3¿I
Mailing Address:417 Main St. Carbondale, CO 81623
EmaitAddress: jt@tebuilders'net
Engineer; _ Cl3OSepticeonsulting--l'hon e:{ 970 )309-52159
Mailing Address:
Ëmail Address:
129 Cains Lane Ci¡rbondale, CO 81623
CARLA.OSTBERGGDGMAIL.COM
PROJECT TOCATION AND DESCR¡PTION
Job Address T.B.D CR 237 SII T,IRIFI F
Assessor,sParcelNumbe1:21272:4400392suu.-Lot-lBlock-
Buitding or Service Typer RES.!!)ENTIAL ' D{E!!!¡lli-#Bedrooms; ?-
-Garbage
ttisposal(Y/N) Y
Distance to Nearest Community Sewer System;N/A
Was an effort made to connect to the Contmunity Sewer System:
Potable Water Source m
&Type !
Ü Stream or Creek fJ cistern
Nanre
Garfield County Public Health Department * working to promote heallh and prevent disease
CgRTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additionaltests 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
neceisãry 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 evaluatin¡¡ 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 ancl legal action for perjury
as provided by law.
I hereby actr<nowledge that I have read and understand the Notice and Certific¿rtion above as
well as have provided the required information which is correct and accurate to the best of
my knowlerdge.
7/n5 /*-
Owner Print and Sign / DilÁ
OFFICIAI USE ONLY P¡rrp. * l?3.0è. C, C. è1 l.S lzoz1 Åæ
Special Conditions
Permit Fee:
S tzs,æ
Total Fees:
* lz3,ocr
Fees t'âid:f ¡¿3.oo
Building Permit
gLR.e -7t 18
OWTS Permit:
SE?f'1 6t?
lssue Date Balance Ðue:+d
Garfield County Public Health Departmerlt:
Signed Approval Date
8/31/2022