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Home My WebLink AboutApplicationSt New Installation — _ ❑ Alteration rDw!e Transient Use ❑ Comm/Industrial ❑ Non -Domestic ❑ Other Describe ` i it Phone: ( Mailing Address: L Contractor: ref ,i� .rte 1�4Jt Phone• Mailing Address: Engineer:�r,1g Mailing Address. l o% Joie Address:Z. 1 �v Assessors Parcel Number: � �00� 'Sub. I 5ab. – _ Lot Block Building or Service Type: q i M M't #Bedrooms:_ Garbage Grinder Distance to Nearest Community Sewer System: Was an effort made to connect to the Community Sewer System: Type of ISDS SepdcTank p Aeration Plant Cl VauR O Vault Privy ❑ .[ompostirigioilet !, Recycling, Potable Use ❑ Recycling p Pit P&y. O Incineration Toilet K ❑ ChemiraIToilet p Ground Conditions Depth to la Ground water table Final Disposal by li Abruption trench, Bed or Pit Cl Evapotranspiration 11 r i rt I Percent Ground Slope , Y — Underground. Dispersaq E1 Above Ground,Dispersal :. Water Source & Type 4);-Weli—TI-3 Spring 113 stream or Geek E3 Community Water System Name_ Effluent Will Effluent be discharged dlrectlyinto waters to the Cistern Yes tj: No. 900vS000t saiuoll U.101sa,Ii qua,iD V9ZZ6£96TLT Xdri Zt:ZT £T09/'Z0/9T 2 0- rh N Garfield County o ; Lc: munity Development Department Q 108 8" Street, Suite 401 (D Glenwood Springs, Co 81601 (970) 945-8212 www.Ftarfield-county.com St New Installation — _ ❑ Alteration rDw!e Transient Use ❑ Comm/Industrial ❑ Non -Domestic ❑ Other Describe ` i it Phone: ( Mailing Address: L Contractor: ref ,i� .rte 1�4Jt Phone• Mailing Address: Engineer:�r,1g Mailing Address. l o% Joie Address:Z. 1 �v Assessors Parcel Number: � �00� 'Sub. I 5ab. – _ Lot Block Building or Service Type: q i M M't #Bedrooms:_ Garbage Grinder Distance to Nearest Community Sewer System: Was an effort made to connect to the Community Sewer System: Type of ISDS SepdcTank p Aeration Plant Cl VauR O Vault Privy ❑ .[ompostirigioilet !, Recycling, Potable Use ❑ Recycling p Pit P&y. O Incineration Toilet K ❑ ChemiraIToilet p Ground Conditions Depth to la Ground water table Final Disposal by li Abruption trench, Bed or Pit Cl Evapotranspiration 11 r i rt I Percent Ground Slope , Y — Underground. Dispersaq E1 Above Ground,Dispersal :. Water Source & Type 4);-Weli—TI-3 Spring 113 stream or Geek E3 Community Water System Name_ Effluent Will Effluent be discharged dlrectlyinto waters to the Cistern Yes tj: No. 900vS000t saiuoll U.101sa,Ii qua,iD V9ZZ6£96TLT Xdri Zt:ZT £T09/'Z0/9T e- _. "noNEv ��_App icant aes that the completeness the application is conditional upon such further - 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, 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 require 'n ormation which is correct and accurate to the best of my knowledge. r fJ Prope Owner P ' t and gn pa 9000: 9000 I1 sowap uJalsatµ JUDJD VGZZBC96TLT xVJ tb : ZT ETOZ: Z0: ZT GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 401 Permit Glenwood Springs, Colorado 81601 Assessor's Parcel No. Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constitute a building or use permit. PRO_ P Owner's Name �/� t� Present Address S -� z C�-3Z�Phone System Location Legal Description of Assessor's Parcel No. � %3� Z SYSTEM DESIGN Septic Tank Capacity (gallon) Percolation Rate (minutestinch) Required Absorption Area - See Attached Special Setback Requirements: Date Inspector Other Number of Bedrooms (or other) FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering installation System Installer Septic Tank Capacity s� C Septic Tank Manufacturer or Trade Name CN C� Septic Tank Access within B° of surface Absorption Area � rgj -S V LL/ 7/� 2 Absorption Area Type and/or Manufacturer or Trade Name .3 ;/ 5 �r A J Adequate compliance with County and State regulationstrequirements Yr s Other G Inspector Date 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