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195 w. 14th street
Rifle, CO 81650
(970) 62s-s200
Public Heulth
OWTS PERM IT APPLICATION
2014 Blake Avenue
Glenwood Springs, CO 81601
(970)s4s-6614
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PROJECTLOCATION AND
Job Address:
Nu
Building or Se
Distance to Nearest
Was an effort made
Lot Block
Disposal(Y/N)_
System:
to connect to unity Sewer System:
Gurlield Coun$
TYPE OF SYSTEM CONSTRUCTION
![ Alteration tr Vault and Haultr New lnstallation El Major Repair E Minor Repair
BUILDING USAGE WPE -,- -,
Non-trtr Comm./ltr Dwelling E Transient Use
E Other Describe
tNvoLvED PARTIES (
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Property
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Email Address:
Mailing
Mailing Address
Email Address:
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Mailing Address
Email Address, €r tu i
Engineer:
E Well tr Spring E Stream or Creek E Cistern
E CommunityWaterSystem Name
Potable Water Source
& Type
Garfield County Public Health Department - working to promote health and prevent disease