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HomeMy WebLinkAboutApplication-Pending195 W. 14th Street Rifle, CO 81650 (970) 62s-s200 2014 Blake Avenue Glenwood Springs, CO 81601 (s70) e4s-6614Public Heslth OWTS PERM IT APPLICATION E Other Describe Recreational Cabin Gurfield County TYPE OF SYSTEM CONSTRUCTION fl vajor Repair E Minor Repair ! Alteration E Vault and HaulNew lnstallation BUILDING USAGE TYPE n Comm./lndustrial E Non-Domesticn Dwelling E Transient Use INVOLVED PARTIES Property Owner: Chance Robbins Pho ne: (szs l76o-i077 Mailing Add ress: 54000 country Rd 53.1 Trinidad, co 81082 EmailAddress:ChanceFlohLrinsT@omail com Contractor: Kevin Schlabach - Alpine Buildinqs Phone: {gzo )zoo-gozt Mailing Address: 1575 CR 17 ll2LomaCO 81.524 . EmailAddress:aloine.buildinos@outlook.com Engi Kachavla Cronk Phone: (gzo )250-0572 Mailing,Add 'i'i ress: PO Box''|40 Mack CO 81525 EmailAddress:cronk@outlook.com PROJECT LOCATION AND DESCRIPTION Project Address:TBD- Countv Rd202 DeBeque, CO 81 Assessor's Parcel Number:2415-041-oo-ootSub. Lot Block Building or Service Type:Recreational #Bedroo ms:1 Garbage Disposal(Y/N)N Distance to Nearest Community Sewer Syste ffi:10 Miles Was an effort made to connect to the Community Sewer System:No Potable Water Source & Type E well I Spring E Community Water System Name Garfield County Public Health Department - working to promote health and prevent disease CERTIFICATION plicant acknowledges that the completeness of the application is conditional upon such rther mandatory and additional tests and reports as may be required by the local health partment to be made and furnished by the applicant or by the local health department for urpose of the evaluation of the application; and the issuance of the permit is subject to such ms and conditions as deemed necessary to insure compliance with rules and regulations ade, information and reports submitted herewith and required to be submitted bythe pplicant are or will be represented to be true and correct to the best of my knowledge and elief and are designed to be relied on by the local department of health in evaluating the same r purposes of issuing the permit applied for herein, I further understand that any falsification r misrepresentation may result in the denial of the application or revocation of any permit nted 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 wl Kevin Schlabach October 7,2O25 Owner Print and Sign Date ? OFFICIAL USE ONLY Special Conditions: Permit ree:(O@ ,@ TotatFees:k@,Q 'Fees vaia(ln@ Building Permit-owrsffi/..ftc{:)lssue Date:Balance Due(> Garfield County Public Health Department: Signed Approval Date Garfield County Public Health Department - working to promote health and prevent disease