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t GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Nc 3 2 8 2 p'f
e h 109 8th Street Suite 303 Assessor's Parcel No. I
I Glenwood Springs, Colorado 81601 a C
p Phone (303) 945.8212
6
t ? This does not constitute 4
3 INDIVIDUAL SEWAGE DISPOSAL PERMIT ,l y a building or use permit. (
i G / /
f PROPERTY
' ppp ��, n l n � 1 5 . g163 p y
Owner's Name H f e J k• , ` rese E Address Pt o( 7 Gt�p�u►� Phone v / o 7 r 57 "
System Location C O(I1�1� R a 10 �f A�Z"? C)C-e vile flue) ;
s Rr Cie C o 8 165 - 0
t ; Legal Description of Assessor's Parcel No. 1
rt oC L &A'M -- FfEt0 14 64 t t'
t SYSTEM DESIGN t C Ac H 014A (3E0 41 vN ftS ?D
tr i / T4 6A"i -5 - - S e 1I — '1 �
O 0 Septic Tank Capacity (gallon) Other
r k 1 1/V Percolation Rate (minutes /inch) Number of Bedrooms (or ot her) 3
l '
Required Absorption Area - See Attached C N WE- C � L✓ A T E- r('4 0 £
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I tt Special Setback Requirements: : 1
t
Date 1 1 '� , '1 Inspector A `' r r
it ft
4 FINAL SYSTEM INSPECTION A APPROVAL (as installed)
Call for Inspection (24 hours no ce) Before Covering Installation ; i.
iii
4 I System Installer GI i3 5 E-45 E 4
t
Septic Tank Capacity . ti—Cr) '6 '.
* . CoP1E.L4- )b s
Septic Tank Manufacturer or Trade Name f
r ;
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I Septic Tank Access within 8" of surface .— E 4
, ' Absorption Area 3 TR1: )C' f/'ff S 411TH 15 �Cfl 6 r L� -.(-C ff C/{�T1�'E
1, t1
1 Absorption Area Type and /or Manufacturer or Trade Name :, , t
1 Adequate compliance with County and State regulations/requirements ' ■
FR
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' i Other ,� /� // r
r D 2— y'r Inspector de.. ! -!. L-. v , �
+ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE r
e r s .
1 r *CONDITIONS: n
r 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R.S. 1973, Revised 1984. - b
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- t''
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a 'a i
I requ of the permit and cause for both legal action and revocation of the permit.
i rt 3. Any person who constructs, alters, or installs an individual& eWage disposal s in a manner which involves a knowing and material t :
is "• variation from the terms or specifications contained in theapplication of permit commits a Class I, Petty Offense ($500.00 fine — 8 I? f,
months in Jail or both). y .,
)s 1
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White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER l uFPlfS F • {76ybE cr .
ADDRESS p.0 1 -1097 &JPC )pu ,e-nQ)ILS7 PHONE 9 7 o 4 /g -S572—
CONTRACTORTh/3Ur7) (...pghbr- .
ADDRESS 59 �.t)ugr /a. Z)q l*r.) acne, Qo PHONE 970- v-7)2
PERMIT REQUEST FOR (k() NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town P--;%-c-le Size of Lot 9 • 1q
11l SE S
Legal Description or Address j R!) CP ZIo laiQIF. ,ir>. P /hs
WASTES TYPE: ( DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVIC : 160o s%Pt n Pt -ln+o� )610 —
Number of Bedrooms ,/ 3n.n /, a-r Day Number of Persons 2
( ) Garbage Grinder (ar) Automatic Washer (x) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (e) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:A //A
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System ?,
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2