HomeMy WebLinkAboutApplicationGørfteld County
195 w. 14th street
Rifle, CO 81650
(970) 62s-s200
Public Health
OWTS PERMIT APPLICATION
2014 Blake Avenue
Glenwood Springs, CO 81601
(e70) e s-6614
TYPE OF SYSTEM CONSTRUCTION
E New lnstallation E Alteration post constr. permit
BUITDING USAGE TYPE
E Dwelling E Transient Use lñ Com m./ln¿uiti¡ái
El other DeSCfibg dettached bodroom suite
tr Repair
Non-Domestic
INVOTVED PARTIES
Property Owner:.Paul s Robvn wulov Phone (712 )249 28lr
Mailing 1776 County Road 24l,New Caslle CO 81647
Email Addressr robyn.whåley'l 3@gmall.com
ne:( )
Mailing Address:
Email Address:
Sopr¡s , Paul Rutledge & Yancy N¡chol lorn ) 704 031 I
MallingAddress:502 irain Strsst, Suite 43, Carbondåle, CO 81623
Email Address:prutlôdgs@sopriseng.com
PROJECT TOCATION AND DESCRIPTION
Job Address:1776 County Roâd 241, N€w Castle cO 81647
Assessor's Parcel N
Building or Service
Distance to Nearest Commun¡ty SewerSystem > 5 mlle
Was an effort made to connect to the Community Sewer System:N/A
212318300001 Lying Ely of New Harris oitch lot 3
âddil¡onel bedrooms only (no kltch€n, løundry)2
Well E Spring E stream or Creek I clstern
rbage Disposal(Y/N)rc
Potable Water Source
& Type E Communlty Water syitem Name
Garfield County Public Health Department - working to promote health and prevent disease
Anplic¡nt acknowledras that the completeness of the appllcatlon l¡ cgndltional upon such further
nian¿ãlorv ãnd addnTonai tests and rdoorts as mav be i'ehutred bv thc local heatth department to be
made and'furnished by the opplicant or by the locál health dep¡rtmqm for purpose of the evaluatlon of
the aoplicatlon; and tlie lssuritice öf the p'ármlt is subject to sr.ich terms and-condltlons as deemed
neceis'ary to lniure compllancc wlth rulés and regulailons made, infiormatlon and reporB submlttcd
herewlth'e nd requlrod tó bo submlttcd by the gpÞlicant are or will be represented tó be true and
correct to the bebt of my knowled8e and bellef ànd are designed to be relied on by the local
department of health ln.ev¡lurtlng the same for purposcs of i¡sulng the permit applicd for herein. I
further understand that any falslfiıatlon or mlsrepresentat¡on mayiesult in the denlel of the
appllcatlon or revocation of any permlt grrntcd based upon sald a'pplication and legal action for perjury
ai þrovided by law.
I hereby acknowledge that I have read and understand the Notlce and Certlflcatlon above as
well as have provided the required informatlon which is correct and accurate to the best of
my
Owner Print and Sign
Speclal Condltlons:
'*i'&.ooPermlt Fee:lâ3 .oo
Total Fees:\A3 .OO
OWTS Permlt:
SF.VT-1485
lssue Date:
031r012023
aatanceo6Building Permlt
BI-Q.E-?cìåL
0311,012023Garfleld County Publlc Hêalth Department¡
Slßned Approval Datê
øl¿ ¿ a.'61íu-
I'age 5 of i
Uptlnle{ l}r'r 2Ul1ì