HomeMy WebLinkAboutApplication-Permit.pdfI Garfield County Building & Planning Department 108 8th Street, Suite #401 Glenwood Springs, Co. 81601 Office:970·945·8212 Fax: 970·384·3470 Inspection Line: 970·384·5003 Building Permit
No. J\:)11 Parcel No: 2393-284-09-016 Locality: ···--· Cooperton townsite, blk9,1ots 6,7,8&9 Job Address: 70 Cedar St, Carbondale Use of Building: relocate s/f on to new foundation/basement.
Owner: .. Perry, Jean Contractor: Owner ·----Fees: Plan Check: $ 392.18 Septic: $ Bldg Permit: $ 603.35 1 lv modu fee: $ --.. Total Fees: $ 1,468.53 ·---73.00 400.00 ~ Clerk: Date: 5.2~Q.01
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2 3 4 5 6 7 8 9 10 II Garage: 12 GARFIELD COUNTY BUILDING PERMIT APPLICATION 108 8th Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-8212 /Fax: 970-384-3470 I Inspection
Line: 970-384-5003 www .garfield-cmmly .com o Alteration o Addition Septic: o Detached li!1SDs Owners valuation of Work: S NOTICE ~· This application for a Building Permit must be signed
by the Owner of the property, described above, or BJJ authorized agent. If the sigllllture below is not that of Ute Owner, n separnle leiter of authority, signed by the Owner, must be
provided with this Application. !&Cal An .... A Building Permit cannot be issued witbolll proof oflegal and adequate nccess to the property for pwposes of inspections by the Building
Department. Other Penni h. Multiple sepRlllle permits may be required: ( I) State Electrical Pcrmi~ (2) Cow1ty ISDS Permit, (3) BJJother permit required for use on the properly identified
obove, e.g. Stale or CollOty Highway/Road Access or a Stale Wostewater Discharge Permit. V9ld Permit A Building Permit becomes null and void if the work outl•oriu d is not commenced
within 180 days oft he dote of issuance Md if work is suspended or abandoned for a period of 180 days after commencement. CERTIFICATION I hereby celliJY that I have read this Application
and that the infonnatioo contained above is true and correct. l llllderstand that the Building Department accepts the Applicatim~ along with the plans and specifications and other data
submitted by me or on my behalf(submillals), based upon my certification as to accuracy. Assuming completeness of 01e submittals and approval of this Application, a Building Permit will
be issued granting pcrmi.sion to lllO, M Owner, to construct the structure(s) and facilities det1liled on the submittals reviewed by the Building Department. ln consideration of the
issuMcc of the Building Permit, I agree that I and my agents will comply with provisions of any federal, state or local law regulating the work and the Garfield CollOty Building Code,
ISDS regulations and applicable land use regulations (County Regulatioo(s)). I acknowledge that the Building Permit mny be suspended or revoked, upon notice from the Couoty, if the location,
construction or use of the structure(s) and focility(ies), described above, are not in compliance with County Regulotion(s) or any other O(lplicoble law. I hereby grant permission to
the Building Deportment to enter the property, described above, to inspect tl1e work. I further acknowledge thntthe issuance of the Building Permit docs not prevent the Building Official
from: (I) n:q>tiring the correction of errors in the submittnls, if any, discovered after issuance; or (2) stopping construction or use of the structure(s) or fncili ly(ies) if such
is in violation ofCOUJII)' Regulotion(s) or any other applicable law. Review of this Application, including submittals, and inspections of the work by the Building Department do not
constitute an accepiMcc of responsibility or liability by the County of errors, omissions or discrepancies. As the Owner, I acknowledge that responsibility for compliance with federal,
stale and local lows Md Collllty Regulations rest with me and my aulhoriud agents, including without limitation my architect designer, engineer and/or builder. I HEREBY ACKNOWLEDGE THAT
I HAVE READ AND UNO ERST AND THE NOTICE & CERTIFJCATION ABOVE: OWNERSS STAFF USE ONLY Sp<<;,o C...Utioooo .t, fiCJ4 ~ ;<. 441.00 '5ST"J., Adjusted Valuation: Plan Check Fee: Permit Fee:
Mllml home Fee: Mise Fees: 45'~.cv -¥f~. t8 (po~.~s 4raJ,(O ~~ 2~-Dq ISDS Fee: Total Fees: Fees Paid: IB Balance Due: BP No & Issue~ ISDS No & Issued Date: 1":J.{X) 14&6.~ ?512.. 107~.~5
ll =j\1 4lt6f Setbacks: OCCGroup: ConstType: Z[Zg(iA B~DEPT: ~ 5/U/£1 P~GDEPf' ~ • ~~ ~ ~~~~ £/~tP/o:z APPROVAL DATE AP ROYAL'( 11' DATE
The following items are required by Garfield County for a final Inspection: 1) A final Electrical Inspection from the Colorado State Electrical Inspector. 2) Permanent address assigned
by Garfield County Building Department and posted at the structure and where readily visible from access road. 3) A finished roof; a lockable building; completed exterior siding; exterior
doors and windows installed; a complete kitchen with cabinets, sink with hot & cold running water, non-absorbent kitchen floor covering, counter tops and finished walls, ready for stove
and refrigerator; all necessary plumbing. 4) All bathrooms must be complete, with washbowl, tub or shower, toilet, hot and cold running water, non-absorbent floors, walls fmished, and
privacy door. 5) Steps over three (3) risers, outside or inside must be must have handrails. Balconies and decks over 30" high must be constructed to all IBC and IRC requirements including
guardrails. 6) Outside grading completed so that water slopes away from the building; 7) Exceptions to the outside steps, decks, grading may be made upon the demonstration of extenuating
circumstances., i.e. weather. Under such circumstances A Certificate of Occupancy may be issued conditionally. 8) A final inspection sign off by the Garfield County Road & Bridge Department
for driveway installation, where applicable; as well as any final sign off by the Fire District, and/or State Agencies where applicable. A CERTIFICATE OF OCCUPANCY (C.O.) WILL NOT BE
ISSUED UNTIL ALL THE ABOVE ITEMS HAVE BEEN COMPLETED. A C.O. MAY TAKE UP TO 5 BUSINESS DAYS TO BE PROCESSED AND ISSUED. OWNER CANNOT OCCUPY OR USE DWELLING UNTIL A C.O. IS ISSUED. OCCUPANCY
OR USE OF DWELLING WITHOUT A C.O. WILL BE CONSIDERED AN ILLEGAL OCCUPANCY AND MAY BE GROUNDS FOR VACATING PREMISES UNTIL ABOVE CONDITIONS ARE MET. I understand and agree to abide by
the above conditions for occupancy, use and the issuance of a C.O. for the building identified in the Building Permit. DATE
GARFIELD COUNTY BUILDING AND PLANNING 970-945-8212 MINIMUM APPLICATION REQUIREMENTS For SINGLE FAMILY DWELLING CONSTRUCTION Including NEW CONSTRUCTION ADDITIONS ALTERATIONS And MOVED
BUILDINGS In order to understand the scope of the work intended under a permit application and expedite the issuance of a permit it is important that complete information be provided.
When reviewing a plan and it's discovered that required information has not been provided by the applicant, this will result in the delay of the permit issuance and in proceeding with
building construction. The owner or contractor shall be required to provide this information before the plan review can proceed. Other plans that are in line for review may be given
attention before the new information may be reviewed after it has been provided to the Building Department. TWO (2) SETS OF CONSTRUCTION DRAWINGS & TWO (2) SITE PLANS MUST BE SUBMITTEDFOR
ALL APPLICATIONS. Please review this document to determine if you have enough information to design your project and provide adequate information to facilitate a plan review. Also, please
consider using a design professional for assistance in your design and a construction professional for construction of your project. Any project with more than ten (10) occupants requires
the plans to be sealed by a Colorado Registered Design Professional. To provide for a more understandable plan in order to determine compliance with the building, plumbing and mechanical
codes, applicants are requested to review the following checklist prior to and during design. Applicants are required to indicate appropriately and to submit the completed checklist
at time of application for a permit. Plans to be included for a Building Permit, must be on drafting paper at least 18"x24" and drawn to scale. 1
Plans must include a floor plan, a concrete footing and foundation plan, elevations all sides with decks, balcony, steps, hand rails and guard rails, windows and doors, including the
finish grade line and original grade. A section showing in detail, from the bottom of the footing to the top of the roof, including re-bar, anchor bolts, pressure treated plates, floor
joists, wall studs and spacing, insulation, sheeting, house-rap, (which is required), siding or any approved building material. Engineered foundations may be required. A window schedule.
A door schedule. A floor framing plan, a roof framing plan, roof must be designed to withstand a 40 pound per square foot up to 7,000 feet in elevation, a 90 M.P.H. wind speed, wind
exposure B or C, and a 36 inch frost depth. All sheets to be identified by number and indexed. All of the above requirements must be met or your plans will be returned. All plans submitted
must be incompliance with the 2003 IRC. 1. Is a site plan included that identifies the location of the proposed structure or addition and distances to the property lines from each corner
of the proposed structure(s) prepared by a licensed surveyor and has the surveyors signature and professional stamp on the drawing? Properties with slopes of 30% or greater must be shown
on the site plan. (NOTE Section: 106.2) Any site plan for the placement of any portion of a structure within 50 ft. of a property line and not within a previously surveyed building envelope
on a subdivision final plat shall be prepared by a licensed surveyor and have the surveyor's signature and professional stamp on the drawing. Any structure to be built within a building
envelope of a lot shown on a recorded subdivision plat shall include a copy of the building envelope as it is shown on the final plat with the proposed structure located within the envelope.
Yes 'f 2. Does the site plan also include any other buildings on the property, setback easements and utility easements? Please refer to Section 5.05.03 in the Garfield County Zoning
Resolution if the property you are applying for a building permit on is located on a corner lot. Special setbacks do apply. Yes ~ 3. Does the site plan include when applicable the location
of the I.S.D.S. (Individual Sewage Disposal System) and the distances to the property lines, wells (on subject property and adjacent properties), streams or water courses? Yes K ' 4.
Does the site plan indicate the location and direction of the County or private road accessing the property? Yes 'J 2
5. Have you provided any RESOLUTIONS and/or LAND USE PERMIT(S) associated with this property? \/Yes if Yes please provide a COPY. No. _ A-A---6. Are you aware that prior to submittal
of a building permit application you are required to show proof of a legal and adequate access to the site? This may include (but is not limited to) proof of your right to use a private
easement/right of way; A County Road and Bridge permit; a Colorado Dept. of Highway Permit, including a Notice to Proceed; a permit from the federal government or any combination. You
can contact the Road & Bridge Department at 625-8601. See phone book for other agencies Yes } 7. Do the plans include a foundation plan indicating the size, location and spacing of all
reinforcing steel in accordance with the IRC or per stamped engineered design? Yes '/... 8. Do the plans indicate the location and size of ventilation openings for under floor crawl
spaces and the clearances required between wood and earth? Yes )( No ____ _ 9. Do the plans indicate the size and location of ventilation openings for the attic, roof joist spaces and
soffits? Yes. ____ _ No. ___ _ 10. Do the plans include design loads as required by Garfield County for roof snow loads, (a minimum of 40 pounds per square foot up to & including 7,000
feet above sea level), floor loads and wind loads? Yes X 11. Does the plan include a building section drawing indicating foundation, wall, floor, and roof constructio!l:,. Yes /. ·~
12. Does the building section drawing include size and spacing of floor joists, wall studs, ceiling joists, roof rafters or joists or trusses? ·~ l Yes ~. 13. Does the building section
drawing or other detail include the method of positive connection of all columns an~eams? Yes. _ ~~~---14. Does the elevation plan indicate the height of the building or proposed addition
from the undisturbed grade to the midpoint between the ridge and eave of a gable or shed roof or the top of a flat roof? (Building height measurement usually not to exceed 25 feet) Yes
'J.-
15. Does the plan include any stove or zero clearance fireplace planned for installation including make and model and Colorado Phase IVertifications or phase II EPA certification? Yes
No ______ ~~-----16. Does the plan include a masonry fireplace including a fireplace section indicating design to comply with the IRC? Yes. _________ No ____ ,,F>(,__ ___ 17. Does the
plan include a window schedule or other verification that egress/rescue windows from sleeping rooms and/or basements comply with the requirements of the IRC? Yes 'j. 18. Does the plan
include a window schedule or other verification that windows provide natural light and ventilation for all habitable rooms? Yes ')C 19. Do the plans indicate the location of glazing
subject to human impact such as glass doors, glazing immediately adjacent to such doors; glazing adjacent to any surface normally used as a walking surface; sliding glass doors; ftxed
glass panels; shower doors and tub enclosures and specifY safety glazing for these areas? Yes No __ -7)(~--------20. Is the location of all natural and liquid petroleum gas furnaces,
boilers and water heaters indicated on ~=tlan? 7f /OC~ (-,__ et£.L?,tJy r;/-vJ.c.izvu_, f\..-UA) /o c... .c x. .• ·f.-t." ~ +bcJ....-.•. 21. Do you understand that if you are building
on a parcel of land created by the exemption process or the subdivision process, are building plans in compliance with all plat notes and/or covenants? Yes 'j-22. Do you understand that
if you belong to a Homeowners Association (HOA), it is your responsibility to obtain written permission from the association, if required by that association, prior to submitting an
application for a building permit? The building permit application will be accepted without it, but you run the risk of the HOA bringing action to enforce the covenants, which can result
in revocation of permit issued. Additionally, your Plan Review fee is not refundable if the plans have been reviewed by the Building Department prior to any action by the HOA that requires
either revocation or substantial modification ofthe plans. Yes )( 23. Will this bet e only residential structure on the parcel? Yes No lfno-Explain: ___________ _ 24. Hav~ !:o (2)<:mplete
sets of construction drawings been submitted with the application? 4
25. Do you understand that the minimum dimension a home can be on a lot is 20ft.wide and 20ft. long? Yes )(: I 26. Have you designed or had this plan designed while considering building
and other construction code requirements? Yes )t 27. Do your plans comply with all zoning rules and regulations in the County related to your properties zone district? Yes X 28. Does
the plan accurately indicate what you intend to construct and what will receive a final inspection by the Garfield County Building Department? Yes)( J 29. Do you understand that approval
for design and/or construction changes are required prior to the application of these changes? Yes 'f. 30. Do you understand that the Building Department will collect a "Plan Review"
fee from you at the time of application submittal and that you will be required to pay the "Permit Fee" as well as any "Road Impact" or "Septic System" fees required, at the time you
pick up your building permit? Yes 'J 31. Are you aware that you must call in for an inspection by 3:30 the business day before the requested inspection iu order to receive it the following
business day? Inspections will be made from 7:30 a.m. to 3:30 p.m. Monday through Friday. Inspections are to be called in to 384-5003. Yes "/--No _____ _ 32. Are you aware that requesting
inspections on work that is not ready or not accessible will result in a $50.00 \Jnspection fee? Yes. _::; ,._,_. ___ 33. Are you aware that you are required to call for all inspections
required under the IRC including approval on a final inspection prior to receiving a Certificate of Occupancy and occupancy of the building? Yes ')L 5
34. Are you aware that the Permit Application must be signed by the Owner or a written authority being given for an ~;ent and that the party responsible for the project must comply with
the IRC? Yes _ -t'Ao"'"--35. Do you understand that you will be required to hire a State of Colorado Licensed Electrician and Plumber to perform installations and hookups, unless you
as the homeowner are performing the work? The license number of the person performing the work will be required at time of applicable inspection. Yes ---,P-------36. Are you aware, that
on the front of the Building Permit Application you will need to fill in the Parcel/Schedule Number for the lot you are applying for this permit on prior to submittal of a building permit
application? Your attention in this is appreciated. Yes ¥ 3 7. Do you know that the local fire district may require you to submit plans for their review of fire safety issues? '! Yes
A. (please check with the building department about this requirement) 38. Do you understand that if you are planning on doing any excavating or grading to the property prior to issuance
of a building permit that you will be required to obtain a grading permit? Yes '/. 39 . Are you aware that if you will be connecting to a public water and/or sewer system, that the tap
fees have to be paid and the connections inspected by the service provider prior to the issuance of a Certificate of Occupancy? Yes X 40. If you anticipate obtaining a water tap from
the City of Rifle, please provide a letter indicating that the City will provide water service. No building permit application will be accepted without such a letter. Yes I hereby acknowledge
that I have read, understand and answered these questions to the best of my ability. Q Date 1 Phone: 903' 0 ?!5"] (days); ____$u .f'l dl!l=-<-L-'-'e __( e venings) 6
Project Name: __+ -f-L<e£"1-W('C)q_--.-f!~d·~€.-3:.J..-'c~·L w~--'-c"""e~,/___ Project Address: 7 0 c~ ,Sf Cu/xmdole_. co Notes: If any required information is missing delays in issuing
the permit are to be expected. Work may not proceed without the issuance of a permit. If it is determined by the Building Official that additional information is necessary to review
the application and plans to determine minimum compliance with the adopted codes, the application may be placed behind more recent applications for building permits in the review process
and not reviewed until required information has been provided and the application rotates again to first position for review, delay in issuance of the permit or delay in proceeding with
construction. bpminreqs1Jan2009 7
January 21, 2010 Garfield County Building & Planning Dept. 1 08 8th Street Suite 401 Glenwood Springs, CO 81601 Dear Planners: R CE V J JAN 2 1 2010 GARF LU COUNTY BUILDit & PLANNING
On May 26, 2009 we received a building permit(# 11311) from Garfield County. Unfortunately the entire process has taken longer than we anticipated. We completed the basement foundation
and that was inspected on July 15th (footing) and July 24th (foundation/grouting.) We have moved the existing house onto the foundation and are now in the process of finishing the remainder
of the work necessary to apply for our CO. We respectfully request an extension in order to finish. Thank you for your consideration. Sincerely, Jean Perry 88 Cedar Street Carbondale,
CO 81623 ~) ..
BUILDING PERMIT GARFIELD COUNTY, COLORADO INSPECTION WILl NOT BE MADE UNLES:i TH1S CARD l5 POST£0 ON THE JOP. Date Issued __5~ 2-...b.....,_.._,C:_"J~~--1-------Permit No. --'\._.lc..~""'-'~-l~------
--~ AGREEMENT In consideration of the issuance of the permit, the applicant hereby agrees to comply with all laws and regulations related to the zoning, location; construction and erection
of the proposed structured for which this permit is granted, and further agrees that if the above said regulations are not fully complied with in the-zoning, location, erection and construction
of the above described structure, the permit may then be revoked by notice from the County Building department and IMMEDIATELY BECOME NULL AND VOID. Use retoo.Ue ~h ori\D nt'W ~OUV\dblWf\
I bn_'€mtvrt". Address or Legal Description ]0 C(od.f!r !l.\. 1 Ctr't!Dn 00\f owner fER'-f 1 .. \ean Contractor OWY'If( Building Permit Type f?eS.ldfnftoL This Card Must Be Posted So
It Is Plainly Visible From The Street Until Final Inspection INSPECTION RECORD Footing Driveway /45'-09 i/Ft"'/1 ct<_-211!2 Foundation I Grouting p;cc.;< hoif£/S ol( /0-$'~/0~ Insulation
-:-/Underground Plumbing Drywall 9'-hs-!o 7?7?'Z ~ Rough Plumbing Electric Final (by State inspector) ''''""?J'f::, t3F (o/25/ro Rough Mechanical Septic final~ Gas Piping FINAL //-;<J-10
~/~ _.,.. Electric Rou~h (by State lnsp~ctor) <_ -i-/Jf-.' _.: .' -; /' ('lou Must Call For Final Inspection) (Prior to Framing) Notes Framing 1/VTt:CiftoK IDI"-(to include Roof in place
& Windows & Doors installed & Firestopping in place) THIS PERMIT IS NQJ:,TRANSFERABLE For Inspection Call 970-384-5":.-... 3 Office 970-945-3212 108 8th Street, Suite 401 Glenwood Springs,
Colorado 816m APPROVED..:::_ "'\I-,~ Date ~ • tJ1I&. \I:J .'-' I DO NOT DESTROY THIS CARO ByT~Drmo~~ PROTECT PERMIT FROM WEATHE rJlGE ~ (DO NOT LAMINATE)
.. i ' ~· h ~. 8~ ·~ g ~ ~· g~ i· "! SEI •• " ~~ ,. •~I•!! d' ~ ~ffi ~= • ~~ ti ~ ·~ ~ ~~ Ji !" ' ll l', ; .[I!J; ; ' ' ' ' i ' ! ! hp ' ; ' /~!. 7' --/-.. f ""{ ' i ! [i ,: 1 ' -,_,
~ : "l"'l' '"'"J •;·;;o iii!ll j! ~ . L.' W1l H~V j)jit 'j>i• :r; ~ ' ' ~£ !d I ' ·~ ; Jj)' ;! " , ~ ! l 0
Parcel Detail Page I of3 Garfield County Assessor/Treasurer Parcel Detail Information Assessor/TreasurerProQ_el1:y Search I AssessorSubset Ql1_~ry I As13essorSales Search Clerk & ReQorder_Reception
Search Basic_l3uilding_C_haracteristics I Tax lnfonnation Parcel Detail Y_alue Detail I Sal(!s D~tail I Residential/Comrnercial Imp_rovernent Detail _Land Detail I Phgtographs I Mill
Levy Revenl!es Detail I Tax Area II Account Number II Parcel Number II 2008 Mill Levy I I 009 II R045455 II 23932S409016 II 60.4S7 I Owner Name and Mailing Address IPERRY, JEAN M & ROBERT
M III Iss CEDARST !CARBONDALE, CO Sl623 Assessor's Parcel Description (Not to be used as a legal description) lsECT,TWN,RNG:2S-7-SS SUB:COOPERTON ITWNSTE. BLK:9 DESC: MERGED LOT I6,7,S
& 9 AS PER AMENDED PLAT OF ILOTS 6,7,S & 9, BLK 9 PRE:R090031 IPRE:R044359 BK:0334 PG:0157 IRECPT:732649 BK:1261 PG:665 IRECPT:5S2S23 BK:105S PG:0431 jBK:0972 PG:0666 Location Physical
Address: IICARBONDALE Subdivision: llcoOPERTON TWNSTE. Land Acres: lio Land Sq Ft: /114,500 II II http://www. garcoact. com/assessor /parcel.asp ?Parce!N umber=23 93 2S4090 16 I I I
I I I I I I I I I I I 5/22/2009
Parcel Detail lli====Se=ct=io=n =~1:=1 =T=o=wn=sh~ip==I:~==R=a~ng=e ===ill I 28 I 1 II 88 I 2009 Property Tax Valuation Information II Actual Value II I Land: II 200,oooll I lmJlrovements:
I/01/I Total: II 200,oooll Additional Value_Detail Most Recent Sale II Sale Date: I ~~============S~a~le~P~r~ic~e:~l Additional Sales Detail Assessed Value I 58,0001 0 58,0001 Basic
Building Characteristics Number of Residential 0 Buildings: Number ofCommllnd Buildings: 0 No Building Records Found Tax Information I Tax Year II Transaction Type II Amount I I 2008
II Tax Payment: Whole II ($2,265.84)1 I 2008 II Tax Amount II $2,265.841 --------------------------JoJ:J ofi'_age Assessor Database Search Options I Treasurer Dat<tbase Search Oj:Jtions
Clerk & Recorder Database Seerch Oj:Jtions Garfield CoUJ1tY Home Page http://www. garcoact. com/assessor/parcel.asp ?P arcelN umber=23 9 3 2 84090 16 Page 2 of3 5/22/2009
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 401 Glenwood Springs, Colorado 81601 Phone (970) 945-8212 ~~ -i~ 73r-:! l L>j r N6 c-" 'I'> l INDIVIDUAL SEWAGE
DISPOSAL PERMIT Permit 4651 Assessor's Parcel No. a building or use permit. CAolWNlJ¥ Lb Owner's Name~ t:::f?..i--'/,, \£1{N Present Address ffi( EJ"Y-\lL ~~ PROPERTY Phone0l/6, Cfi!Df-'
System Location Tu r EI:f1J2--s I . C'/A-f?.&~l E. Legal Description of Assessor's Parcel No. l-~ 3. ZE74 · Ol . Q l l 0 SYSTEM DESIGN _____ Septic Tank Capacity (gallon) _____ Other
_____ Percolation Rate (minutes/inch) Number of Bedrooms (or other) ___ _ Required Absorption Area -See Attached Special Setback Requirements: <f.eJ& ~J 7rv~ ~~~-.y~ Date ____________
Inspector ---------r:----------=------6~~ ?:·-<;;<~'-9?o-7oC/-t!/3' II FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation
System Installer ____________ ____________________ _ Septic Tank Capacity-------------------------------Septic Tank Manufacturer or Trade Name-------------------------Septic Tank Access
within 8" of surface-------------------------Absorption Area---------------------------------Absorption Area Type and/or Manufacturer or Trade Name-------------------Adequate compliance
with County and State regulations/requirements ______________ _ Other ____________________________________ _ Date ____________ Inspector----------;'--------------RETAIN WITH RECEIPT
RECORDS AT CONSTRUCTION SITE CONDITIONS: 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. 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Connection to or use with
any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation
of the permit. 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material variation from the terms or specifications
contained in the application of permit commits a Class 1, Petty Offense ($500.00 fine-6 months in jail or both). White -APPLICANT Yellow -DEPARTMENT
1 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 108 8., Street, Suite 40 I, Glenwood Springs, Co 8160 I Phone: 970-945-8212 I Fax: 970-384-3470 I
Inspection Line: 970-384-5003 wv..w.gar fi1 e ld ~coun tv .com ParceiNo:;lh~J ;_/'t~''1"'~t:;.'rn;~~945-(~r/l.n Job Ad,s: (W an?~kt lieen ~e:r( f,~de Cr; 't"' Street 7c& Cl or and legal
desc!iptlon 0 P x '(L( n.v(\.. o.. [e ( D Lo!Si/"4 t;"oo sl LaiNo: (() I <{<('I Block No: q Subd./Exemp~.l~ik & P(rv.. ~)";~,.~~ fu ru_ Mailing Address Ph: AhPh: I u ~~ ~f q&,3-Drf"7
Contracto:~ J)} (J Mailing Address Ph: AhPh: ~<A f.dU.tAeeJ(N L MJingA~z_ M ttU \,\--\to, !f' 1 0'-{-'a> II All Ph: PER REQUEST FORs.J j ( <.1--New Installation ( ) Alteration ( ) Repair
WASTE TYPE: \~welling ( )T ransien!Use ( )Commercial or industrial ( )Non-Domestic wastes ( )Oiher-Describe . BUILDING OR SERVICE TYPE: f e-i I ILPA' . C .JL Number of bedro<i!IS ')f-...,
J Garbage Grinder ( )Yes (vjlllo SOURCE&TYPEOFWATERSUPPLY: ( ~v-a.J.JIR1NfuJl]TREMCR~·( )CISTERN If supplied by COMMUNITY WATER, give name of supplier. {1 0 19-r\._, • DISTANCE TO NEAREST
COMMUNITY SEWER SYSTEM: //I Was an effort made to connect to the Cotnmunlty System? jV(r] YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND
CONDITIONS: (9. ( 1-20/o Depth to 1" Ground Water Table Percent Ground Slope TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED: ( q.leptic Tank ( )Aeration Plant ( )Vault ( )Vault
Privy ( )Composting Toilet ( )Recycling, Potable Use ( iOiher-Describe ( )Recycling, other use ( )Ptt Privy ( )Incineration Toilet ( )Chemical Toilet FINAL DISPOSAL BY: ( )Absorption
trench, Bed or Pit ( )Underground Disperszt_u '£l/,o~1J.~u"}~ ispers~J ~ P: J__lE(apotra":fa'T} f,_ (y safld filterd ., ( )Wastewater pond ( )Other-Describe r1 'JI, :, lut, 'A 'iYLtJfl.ltt
Will effluent be discharged directly Into waters of the state? • ( )YES (t.jNO PERCOLATION TEST RESULT: (to be completed by ~ISler<><! Prufesslonal Engineer, W the Engineer does the
Percoll('n Tesl) AtNJ /{o , Minutes per inch in hole No.1 Minutes I per inch in hole No.3 "' lly'lt Minutes • '<Cf per inch in h~ ~o.2 Min'ts per inch in hole No,_ ' { Name, address
& telephone atRPE who made soil absorption test: ~~-tit u {Ti ~ .)6 --~ot.-"1.1,,: -<;. '1nL/-n ?.11 Name, address & telephone of RPE responsible lor design of the system: "ltU\If..t.
AJ 1 cJ\ ,-I' c.· r: <"'0? lA A_;., 1'1-7 f'J-1 • O_j I Applicant acknowledges that the completeness of the application is conditional upon such fullller mandatory and additional test
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 purposed 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, infonnation and reports submitted herewith
and required to be submitted. by the applicant are or will be represented to be true and correcl 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 tor purposes of issuing the permit applied for herein. I further understand that any falsffication or misrepresentation may resutt in the
denial of the application or revocation of any permit granted based upon said application and legal action tor pe~u ~ .. provided by law. n , 1: ....o 1 ( ) "'/J v -..., ....----'2.
0 9 OWNERS SIGNATURE! v I 'f-.... DATE I I L ' \j STAFF USE ONLY Penn~3 f_::::, u Perk Fee: Total fees: B·rr-3'1'1 ~ 1~>00 Septic Permit#: 4W /Issue Date:. -s.2~-~ Bu~& Plann~e~ < ~
\ \%~ APPROVAL s-;u,;o~ DATE '