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Home My WebLink AboutApplication-PendingGarfield County Public Heulth 195 w. L4th Street Rifle, CO 81650 (970) 62s-s200 2014 Blake Avenue Glenwood Springs, CO 81601 (970l'94s-6614 OWTS PERMIT APPLICATION TYPE OF SYSTEM CONSTRUCTION tr New lnstallation Z lvtajor Repair E Minor Repair E Alteration E Vault and Haul BUILDING USAGE TYPE A Dwelling E Transient Use tr Comm./lndustrial tr Non-Domestic E Other Describe INVOTVED PARTIES Property Owngy; Greg and Julia coon Phone:( e7ob7e-e25s MailingAddrgs5; 256 Old Native lane Glenwood Springs, Co 81601 Email Addressl cmdcoon@gmail.com Sims Construction I qzaleta-taez Mailing Address:256 River Ridge Road Glenwood Springs, CO 81601 Email AddreSS. Bobbuilder@Comcast.net Black Canyon Engineers e:( e7o )568-53e1 Mailing Address:2225 Park Avenue Montrose, CO 81401 Email Address:\Afu att@blackcanyonenqineers.com PROJECT TOCATION AND DESCRIPTION Job Address:256 Old Native lane Glenwood Springs, CO 81601 Assessorr's Parcel N Building or Service 2395021 06052 Westbank Ranch PUC#4 resub 52 Type: single Family #Bedrooms: 5 Garbage Disposal(Y/N)_Y_ Distance to Nearest Community Sewer System : lron Bridqe Was an effort made to connect to the Community Sewer System:No. Distance to far Potable Water Source & Type tr Well tr Spring E Stream or Creek E Cistern Et Community Water System Name Garfield County Public Health Department - working to promote health and prevent disease Greg Coon CERTIFICAT!ON Applicant acknowledges that the completeness of the application is conditional upon srrch frrrther mandatory and additronaltests and reports as may be required by the local health department to be mcde cnd furnishcd by thc applicant or by thc local hcalth dcpartmcnt for purposc of thc cvaluation 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 denial of the application or revocation of any permitgranted based upon said application and legalaction 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. 8t26t2025 Property Owner Print and Sign Date &r* OFFICIAT USE ONIY Special Conditions: Permit Fee:l.rlo 90 Total Fees:lt:lo ,oo Fees Paid:(.fm 9o Building Permit OWTS Permit:H#CqqSI lssue Date:Balance Due:& Garfield County Public Health Department: Signed Approval Date l'larFialal inrrn+rr Drrhlin t-laal+h [.\anaelman+ ,,,ael.i^a la nrama*a h^al+h anA nrarran* niaaaa^vqrr19rw vvurrry r uvilv r rgqrlrr ugPqrttrr9rtt- vvvln[tv tv Ptvtttvtg ttgqtltt qttu ytgvgttr vtD9q09