HomeMy WebLinkAboutApplicationGaffield Counfii
1"95 w, l-4th street
Rifle, CO 81650
(s70) 62s-s200
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OWTS PERM IT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
INVOLVEDPAßNES
Property
2014 Blake Avenue
Glenwood Springs, CO 81601
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PROJECI TOCATION AND DESCRIPNON
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Mailing Address:
Email Address:
Mailing Address
Email Address:
Buildingorservice lvpez 'Bb4.tl,l>o*>t¡J¡vrrt *Bedrooms: |
--GarbageDisposal(Y/N)
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Was an effort made to connect to the Community Sewer System
Assessor's Parcel Num
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Distance to Nearest Community Sewer System:
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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 health in evaluating the same for purposes of issuing the permit applied for herein. I
further understand that anyfalsification or misrepresentation may result in the denialof 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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Property Owner Print and Sign Date
Special Conditions:
Permit Fee:(oú oo Total Fees:æ(oOO ,
Fees Paid:(oæ c)O
Buildine PermitwÎE-ßl+l OWTS Perm¡t:
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lssue Date:Balance Due:
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Garfield County Pubfic Health Department
Signed Approval Date
Ga¡-fiæld üounty Fr:blic l"'le¿:lth ilep:artment -- w*rkìnç t* pr*mr:ft* heallh *nd pr*veni dìsease
07/26/2023
Permit Authorization
I hereby give authorify to my dad, Kirk Eeattio to apply for a buildingpermit forhis
steel building (including residence) and any other permits required by Garfield County
fot his proposed building that will be locater{ on Iny property at 63L County Road 321,
Rifie, Colorado 81650 (Assessor Parcel No. 2177192ût49t). Flease let me know íf you
have any questions.
Dated:15 J .¡\¡r"¿ ËA åjl
Heather Feattie
970-ir40-û97CI
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