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L95 W. t 4th Street
Rifle, CO 81650
(e701 62s-s200
2014 Blake,Avenue
Glenwood Springs, Cò atO0t
(s7o) 94s-6614
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Public Health
OWTS PERMITAPPL ICAT¡ON
WPE OF SYSTEM CONSTRUCTIOI{
New lnstallation E Alteration
BUITDING USAGETYPE
E Transient Use Comm./f ndustrial tr Non-Domestic
E Other Describe
INVOLVÊD PARTIES
Property
MailingAd
Email Address:
MallingAddress
Email Address:
MaillngAddress;
Email Address:
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PROJECT TOCATION
Job Address:
Assesso/s Parcel
Building orService
Distance to Nearest Communlty Sewersystem:
Was an effort made to connect to the Community Sewer System:N['l
Potable Water Source
& Type
ts Disposal(YlNljÊ
Well E StreamorCreek E Cistern
El Community Wðter System Namc
Garficld Coanty
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Garfield County Public Health Department - working to promote health and prevent disease
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01/05/2023
01/06/2023