HomeMy WebLinkAbout3172--------------------------------------------
Check
Cash
Aaae,aor'a Parcel No.
'.-----~~~~-----CHARGES
Percolation Test $100.00
(includes final inspection)
Permit Processing Fee $50.00
Money Order
DE PAYAB'::_ ~ARFIFi !ti:OUNTY TREASURER
While-APPLICANT Yelow-DEPARTMENT
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A .. e .. or'• Parcel No. .. .. 't!' .-----=;-~=-----, · <CHARGES
Peroolalion Test $100.00
Oncludes final inspection)
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Permit
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 Blh Slreel Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945·8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT .,rR
Permit N~ J172
Aaaeaaor'a Parcel No.
This does not constitute
a building or use permit.
PROPERTY ~UJ55 cJ2_1J / Owner'sNameLDujh~~~ PresentAddress ' C.@ l~qCi:f:rDJ Phone C'~4J::o?J
System Location ___ -----;'L=!Zd=---t.=-1 0:1--'+.-"j ----'E::==t~W~S ~-1-----------:· ,-fr:<;. .• ~+.€ ~of--/
Legal Description or Assessor's Parcel No. ~--'-'LD==--) -\"s-'-"'---"~-""J.-+1-LJL4}--l_,_=:O.U-'--'~'-"'z.r..::q=-J-LJ}'-C-fb-J~[..A.=j'--'-.<:£"""'~:.."""--'-' _·
SYSTEM DESIGN
______ Septic Tank Capacity (gallon) -----~Other
______ Percolation Rate (minutes/inch) Number of Bedrooms (or other) ----~
Required Absorption Area -See Attached
Special Setback Requirements:
FINAL SYSTEM INSPECTION A
Septic Tank Manufacturer
Septic Tank Access within 8" o
Absorption Area Type and/or Manufacturer or Trade Na
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 t984.
2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con-
nection 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 I, Petty Offense ($500.00 fine-6
months i_n jail or both).
White· APPLICANT Yellow. DEPARTMENT
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