HomeMy WebLinkAboutApplicationGarfteld County
Public lleulth
195 w. l"4th street
Rifle, CO 81650
(970) 62s-s2oo
2014 Blake Avenue
Glenwood Springs, CO 81601"
(e7o\ s4s-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
! New lnstallation ! Alteration ! Repair
BUILDING USAGE WPE
! Dwelling E Transient Use ! Comm./lndustrial ! Non-Domestic
[] other Describe
INVOLVED PARTIES
Property Owner:Kimber & Steve Ochko e:970 618-18 60
Mailing Address
Email Address:
4362 County Road 100, CarbondaLe, CO 8L623
kimG gouldconstruction . com
Co Goulcl Constructaon, Inc one:l e/u 1 945-729L
Mailing Address:PO Box 130, GLenwood Springs, CO 8L602
Email Address:matt G gouldconstruction . com
Engin cBo s ic Consult hone:( 97O ¡ 309-5259
Mailing Address:129 Cains Lane, Carbondale, CO 8]-623
Email Address: carla. ostbe il-. com
PROJECT LOCATION AND DESCRIPTION
JobAddress: 4362 County Roacl 1OO, Carbondale, CO 4L623
Assessor's Parcel Numbs¡¡ 2 3 9130 1 0 O 027 SEC30TvÍNTFUAI.IGEST lot Block
Building or Service Dwellíng #Bedrooms: 1 Ga rbage Disposal(Y/N) N
Distance to Nearest Community Sewer System:N/A
Was an effort made to connect to the Community Sewer System N/À
Potable Water Source
& Type
ú(well tr Spring E Stream or Creek I Cistern
E Community Water System Name
Gadield County Public Health Department - working to promote health and prevent disease
CERTIFICAT¡ON
Applicant acknowledges that the completeness of the applicatio.n is.conditional upon such further
nìandatory 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.purpo. se of the evaluation of
the application; and tlie issuárice of the permit is su.bject to such terms and conditions as deemed
neceisary to iniure compliance with rules and regulations made,.information and.reports submitted
herewith'and required tò be submitted by the apþlicant are or will be rep.resented to be true and
correct to the beit 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 a.pplied for herein. I
fulther understand that any falsifiıation 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.
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Owner Print a Date
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Special Conditions:
Total Fees:t22,,o?Fees Paid:oot)3Permit Fee: -\\)\,o''
lssue Date Balance Due:
ê
OWTS Permit:
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ldine Permit
Signed Approval
Garfield County Public Health Department:
Date
04/05/2023
04/05/2023