HomeMy WebLinkAboutApplication-PendingGarfield County
Public Health
195 W. 141h Street 2014 Blake Avenue
Rifle, CO 81650 Glenwood Springs, CO 81601
(970) 625-5200 (970) 945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
E New Installation ❑ Alteration ❑ Repair
BUILDING USAGE TYPE
■ Dwelling I ❑ Transient Use E Comm./Industrial ❑ Non -Domestic
❑ Other Describe
INVOLVED PARTIES
Property Owner: Ryobi Foundalion Phone: (970) 9485735
Mailing Address: 13114 Highway 82,Carbondale, CO 81623
Email Address: Bobbi Hapgood <bobbi@ryobifoundation.org> C/o Steve Novy<snovy@greenlinearchitects.corn>
Contractor: Form 44 (John Olson) Phone: 97( 0 ) 379-0643
Mailing Address: Box 10147, Aspen, CO 81612
Email Address: form44@icloud.com
Engineer: 5opris Engineering , Paul Rutledge & Yancy Nichol Phone; (970 ) 7040311
Mailing Address: 502 Main Street, Suite A3, Carbondale, CO 81623
Email Address: prutledge@soprisen .com
PROJECT LOCATION AND DESCRIPTION
Job Address: 13114 Highway 82
Assessor's Parcel Number: 239323403005 Sub. M&B Lot Block
Building or Service Type: residential #Bedrooms: 3 Garbage Disposal(Y/N) N
Distance to Nearest Community Sewer System: > 1 mile
Was an effort made to connect to the Community Sewer System: N/A
Potable Water Source
Well
❑ Spring
❑ Stream or Creek
❑ Cistern
❑ R permit
& Type
❑ Community Water System Name
Garfield County Public Health Department — working to promote health and prevent disease
CERTIFICATION
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 any falsification or misrepresentation may result in the denial of 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.
Barbara Happlood 1t" � 11/6/2025
Property Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Permit FeeeL�-cc:
0
Total Fees:
CoosC1 ^'^JJ
Fees Paid:
0 PO
Building Permit OWTS Permit:
Issue Date:
Balance Due:
Garfield County Public Health Department:
Signed Approval
Date
Pa,)e -5 o f 3
1 pdated Dec 2013