HomeMy WebLinkAboutApplication - PENDINGGarfield County Public Health Department – working to promote health and prevent disease
Public Health
195 W. 14th Street
Rifle, CO 81650
(970) 625-5200
2014 Blake Avenue
Glenwood Springs, CO
81601
(970) 945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
New Installation Major Repair Minor Repair Alteration Vault and Haul
BUILDING USAGE TYPE
Dwelling Transient Use Comm./Industrial Non -Domestic
Other Describe
INVOLVED PARTIES
Property Owner: Phone: ( )
Mailing Address: _
Email Address:
Contractor: Phone: ( )
Mailing Address:
Email Address:
Engineer: Phone: ( )
Mailing Address:
Email Address:
PROJECT LOCATION AND DESCRIPTION
Project Address:
Assessor’s Parcel Number: Sub. Lot Block
Building or Service Type: #Bedrooms: Garbage Disposal(Y/N)
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Potable Water
Source & Type
Well Spring Stream or
Creek
Cistern
Community Water System Name
970
125 CENTER DRIVE #11 GLENWOOD SPRINGS, CO 81601, USA
woodwerxc@gmail.com
WOOD WERX CONSTRUCTION LLC
ARMANDO MELLIN
970
379-7071
379-7071
125 CENTER DRIVE #11 GLENWOOD SPRINGS, CO 81601, USA
woodwerxc@gmail.com
PAUL E. STOFFEL P.E.970 355-9796
213 LINDEN STREET, SUITE 200, FORT COLLINS, CO, 80524
pstoffel@jvajva.com
607 HIGHLANDS DR, GLENWOOD SPRINGS, CO 81601
GLENWOOD HIGHLANDS EST AMD 4AS218505113004
4Single-Family Residence
2.3 Miles (West Glenwood Springs Sanitation District)
N/A
Not Available
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such �urther 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 regulationsmade, information and reports submitted herewith and required to be submitted by the
lapplicant 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 samefor purposes of issuing the permit applied for herein. I further understand that any falsification
lor misrepresentation may result in the denial of the application or revocation of any permit
lgranted 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
l k� (_\ool-MA:u±/�-kh� 1 /2-1: � Property Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee: Total Fees: Fees Paid:
Building Permit OWTS Permit: Issue Date: Balance Due:
Garfield County Public Health Department:
Signed Approval Date
Garfield County Public Health Department -work ing to promote health and prevent disease
$600.00 $600.00 $600.00
City - N/A SEPT-9503 $0.00
Paid 09/24/2025 $600.00 VISA