HomeMy WebLinkAboutApplicationGarfield County
unity Development Department
108 81
h Street, Suite 401
·:1W 0 'J Z014 Glenwood Springs, co 81601
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
{ISDS)
PERMIT APPLICATION
GA:<! 'l l.U CO!JN fY (970~ 945-8212
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TYPE OF CONSTRUCTION • New In stall atio n I D Alt eration I D Repair
WASTE TYPE
D Dwe lling I D T ra n sient Use I D Comm/Industrial I D Non-Domestic
• Other Describe Detached residenti al garage -toilet and sink
INVOLVED PARTIES
Property Owner: Kevin Miln er Phone: ( 91 0 ) 945-8045
Mailing Address : PO Box 302 Glenwood S[2rings CO 81602
Contractor : Owner Phone: ( )
Mailing Address:
Engineer: Glenwood Stru ctura l & Civi l Phone: ( 910 ) 928-01 35
Mailing Address: 812 Pitkin Ave . Glenwood S~ring s CO 81601
PROJECT NAME AND LOCATION
Job Address: ?A7A Hnmi:>c:ti:>:::irl Rn:::irl -~nrinn \/:::illi:>v -C::li:>nwnnrl Snrinnc: --
Assessor's Parcel Number: 218726400014 Sub. H omestead E s t ates Lot 14 Block --
Building or Service Type: D e tached garage #Bedrooms: None Garbage Grinder _Q_
Distance to Nearest Community Sewer System: NIA
Wa s an effort made to connect to the Community Sewer System: NIA
Type of ISDS • Septic Tank I 0 Aeration Plant I D Vault j 0 Vault Pr ivy j D Compo sting Toilet
D Recyclin g, Potabl e Use D Recycling j D Pit Privy j D Incin era tion Toilet
D Chemical Toilet D Other
Ground Conditions Depth to 151 Ground water t able 360'(welldrill report) j Percent Ground Slope 30%
Final Disposal by • Absorption trench, Bed or Pit I D Underground Dispersa l I 0 Above Ground Dispersal
0 Evapo t ran spiratlon 0 Wa ste water Pond I D Sand Filter
• Other Infiltrator chamber trench S)r'.stem - 64 linear feet
-
Water Source & Type •Well j D Spring I D Stream or Creek I D Cist ern
D Community Wat er System Name
Effluent Will Effluent be discharged directly into waters of the State? 0 Yes • No
CERTIFICATION
,
Applicant acknow ledges that the completeness of the application is conditional upon such further
mandatory and addi tional test and reports as may be required by the loc al health department to be
made and furnished by the app li cant or by the loca l hea lth department for purposed of the evaluation
of the application; and the issuance of the permit is subject to suc h t erms and conditions as deemed
necessary to insure compliance with ru les and regulations made, information and reports su bm itted
herewith and required to be submitt ed by the app licant 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 lo cal
department of health in evaluating the same for purposes of issuing the permit app li ed for herein. I
further und ersta nd that any falsification or misrepresentation may r esu lt in the denial of the
application or revocation of any permit grante d based upon sa id application and lega l 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.
-----------'<-~--L------He '1 7-1 20!{
Property Owner Print and Sign
OFFICIAL USE ONLY
Special Conditions:
Perk Fee:
Building Permit
2804
Date
Fee s Paid: CO i/J ~ ,
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